An Integrative Review of Enablement in Primary Health Care

Abstract

In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners' open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health issue, general state of health, ethnicity, the patient's own coping strategies and degree of independence, and socioeconomic status. The association between enablement and patients' expectations and satisfaction is less clear. The majority of research on enablement was carried out among general practitioners. Further research into the degree to which patients are enabled by a wider range of health care providers is needed. Additional qualitative research would provide a deeper understanding of the attributes of enablement in the primary health care setting.

Coping better with health problems after a visit to the family physician: associations with patients and physicians characteristics

“…Besides clinical indicators, patient experience of care is nowadays considered as one of the key components in the quality measurement of a primary care system [ 1 , 2 ]. Patient feeling of confidence and ability to cope with his health problems after a medical visit (through the global concept of enablement) is, among many dimensions used to assess patient experience, considered as an interesting patient-reported outcome measure (PROM) [ 3 – 6 ]. In a recent review of literature, Frost defines the concept of enablement as “an intervention by which the health care provider recognizes, promotes and enhances a patient’s ability to manage their own health” [ 3 ].…”

“…Patient feeling of confidence and ability to cope with his health problems after a medical visit (through the global concept of enablement) is, among many dimensions used to assess patient experience, considered as an interesting patient-reported outcome measure (PROM) [ 3 – 6 ]. In a recent review of literature, Frost defines the concept of enablement as “an intervention by which the health care provider recognizes, promotes and enhances a patient’s ability to manage their own health” [ 3 ]. The studies about predictive factors of enablement are scarce and sometimes contradictory [ 7 ].…”

“…However, male gender, older people, absence of longstanding illness and belonging to ethnic minority groups were found to be associated with a better patient enablement in several studies [ 7 – 9 ]. With the exception of longer consultations [ 7 , 9 , 10 ], few characteristics related to the physician or the organization of the consultation have been found to potentially play a role; and most of them concerned the patient-physician relationship [ 3 , 7 , 11 – 13 ]. Frost et al underlined that further research is needed both to consolidate the results about patients’ predictors and to explore further physicians’ factors [ 3 ].…”

The process of patient enablement in general practice nurse consultations: a grounded theory study

“…, Frost et al . ). General practice nurses (GPNs) play an important role in general practice, however, processes that promote patient enablement in GPN consultations are not understood.…”

“…Patient enablement was first used as a quantitative measure of quality in general practice by Howie et al (1997), who developed the Patient Enablement Instrument, which has been validated and used internationally (Lam et al 2010, Pawlikowska et al 2010, Kurosawa et al 2012. The majority of research examining patient enablement is in relation to general practitioners (Howie et al 1998, 1999, Mead et al 2002, McKinley et al 2004, Mercer et al 2007b, 2008, Pawlikowska et al 2010, Hudon et al 2011b, c, Banerjee & Sanyal 2012, Kurosawa et al 2012, Frost et al 2015. General practice nurses (GPNs) play an important role in general practice, however, processes that promote patient enablement in GPN consultations are not understood.…”