Empowerment

The greatest amount of suffering, disability, and cost occurs when the individual becomes more dependent on tertiary health care. The goal of the primary health team is to reduce this need. This requires that physicians empower individuals, families, and communities to understand what they can do to reduce the risk of disease and move the acuity curve in Figure 2-2 to the left. This will increase control of health by the individual, family, and community, with less dependence on the health care industry. To understand how best to work toward this goal, it is important to understand the process of empowerment.

Empowerment does not mean that patients do what is asked of them; this is compliance. Empowerment is the antithesis of compliance because noncompliance is two people working toward different goals. Empowerment is a way of interacting in which accurate information is provided in a manner understandable to the individual that both respects and promotes patients' ability to make decisions for themselves. A patient's decision making is the "inner," personal environment, influenced by external issues such as culture, family, peer group, work, and payment for care. Anderson and Funnell (2009) describe this well in their research on empowerment and diabetes care, reporting that 98% of diabetes care is "patient directed." When a patient is told to act a certain way, this is successful less than 5% of the time.

Empowerment is both a process and an outcome. The process requires that a health care partner recognizes individuals' unique needs and helps them think critically to make informed decisions on which they choose to act. This results in an outcome that individuals decide is best for them o o

— Patient, family, community

— Health care system

Low Acuity High

Figure 2-2 The Alaska Native Health Care model moved the slashed lines to the left, reducing dependence on the health care system and increasing control of the family. The goal is to flatten the curves to the right. The health care system should empower the family and community to maintain control of their health and make people less dependent on the "health rescue." (Modified from Gottlieb K, Sylvester I, Eby D. Transforming your practice: what matters most. Fam Pract Manag 2008;15:32-38.)

Low Acuity High

Figure 2-2 The Alaska Native Health Care model moved the slashed lines to the left, reducing dependence on the health care system and increasing control of the family. The goal is to flatten the curves to the right. The health care system should empower the family and community to maintain control of their health and make people less dependent on the "health rescue." (Modified from Gottlieb K, Sylvester I, Eby D. Transforming your practice: what matters most. Fam Pract Manag 2008;15:32-38.)

and their current situations. Health care practitioners cannot control their patients' decisions and thus cannot own the outcome. The clinician can recognize the psychosocial and emotional underpinnings that allow positive change to take place, then gradually and supportively work with the patient toward positive behaviors that the patient, family, and community can define with the guidance of their family physician. As the health guide of the community, the relationship-centered health home requires the development of health teams to facilitate this change.

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