Through the patient's eyes: strategies toward more successful contraception.
OBJECTIVE
To review the literature focusing on studies of patient satisfaction and patient involvement in the design of care and to suggest strategies for involving patients effectively in their care. While addressing issues in contraception and adherence to contraceptive regimens, we write from the perspective of general physicians who manage patients with a broad variety of problems. By learning systematically what patients want, need, and experience in health and illness, we can use such information in the redesign and improvement of care.


METHODS
Individual anecdote, focus groups of patients, patient survey data, and a literature review were used.


METHODS
The literature review used an English-language search of MEDLINE from 1970 to 1996, with search terms including patient satisfaction, consumer participation, patient participation, self-care, contraception, and contraceptive behavior. Previous studies conducted by the authors were also reviewed.


RESULTS
Patients report that providers who solicit patients needs and preferences for involvement in decision making, who encourage family involvement, and who tailor educational efforts to the individual adult learning style of the patient engender greater patient satisfaction, adherence to recommended therapies, and improved patient outcomes. Recent trends in the United States, such as the growing use of alternative therapies, the self-help movement, and consumerism have influenced patient attitudes and behaviors toward seeking care and are changing their behavior. We discuss several strategies to improve patient involvement in their care, including the use of patient diaries and contracts, pre- and post-visit preparation and communication, the involvement of patients in educating providers, and the use of information technologies to enhance communication between patients and providers.


CONCLUSIONS
Patient involvement in the redesign of care may help promote greater effectiveness of contraceptive strategies.
Delbanco
T L
TL
Division of General Medicine and Primary Care, Beth Israel Hospital, Boston, Massachusetts, USA.
Daley
J
J
D000328:Adult; D001294:Attitude to Health; D000529:Complementary Therapies; D003267:Contraception; D003268:Contraception Behavior; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011247:Pregnancy