Consumer Enablement Guide

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Why is Enablement Important?

Increasing consumer enablement can help people actively manage their own health, remain in good health and avoid hospitalisations.

The burden of disease is changing. People are living longer, but around half of all Australians have a chronic disease and around 40% aged over 45 have two or more.12 In addition, healthcare practices, technologies and treatments are improving rapidly. The cost of healthcare is rising, and demand for healthcare services is escalating. Consumers have more options and are more informed about their healthcare than ever before. They also have high expectations for the safety, quality and effectiveness of the care they receive.34

Rethinking how we deliver care

Traditional reactive care based on diagnosis and treatment is not always the best approach in this new environment. Managing long-term conditions requires a focus on prevention, proactive care, and self-management skills. To meet current and future healthcare needs, we all, consumers, communities, clinicians, services, systems and governments, need to rethink how we deliver healthcare.

Increasing consumer enablement is one way we can work smarter to achieve better healthcare experiences and outcomes for patients, more rewarding experiences for healthcare workers, and a more efficient healthcare system. Consumer enablement is not new. You probably already use some approaches in your practice. It challenges you to rethink the way services are delivered, so people can effectively self-manage their chronic conditions.

People with high levels of enablement are more likely to:

  • have better outcomes for chronic disease
  • have better physical and psychological health
  • actively manage their own health
  • feel in control (can self-refer, initiate and prioritise actions)
  • be highly aware of their health state
  • self-advocate
  • remain in good health
  • avoid going to hospital
  • participate in research
  • increase their health literacy
  • be familiar with their healthcare providers
  • use technology for monitoring, management and education.

People with lower levels of enablement are more likely to:

  • have complex problems and life circumstances
  • have significant issues in cognitive capacity, psychological status, physical disability or incapacity, and family or community support
  • have poor access to services, language barriers, different cultural norms, and previous negative experiences with health services
  • not know their healthcare providers well.

Health systems are focused on improving efficiency to manage demand with limited resources. By rethinking the way we deliver healthcare, we can work more efficiently and improve the health outcomes of the people in our care.

The Quadruple Aim

The Institute for Healthcare Improvement identified three aims, the Triple Aim, to optimise health system performance and meet the future healthcare needs of the population. This has since been expanded to the Quadruple Aim, which recognises that improving provider experience is key to achieving the other three aims. Consumer enablement contributes to all four goals of the Quadruple Aim.

What is missing from the evidence?

While the strategies in this guide have shown to improve chronic disease management outcomes, it is important to understand the limitations of the evidence available.

Results of studies that try to increase enablement as a means to influence outcomes are mixed and often short-term.

Studies of approaches to increase enablement have been somewhat limited to people with high enablement, as they are more likely to participate in this kind of research.

There is a lack of definitive guidance about what approaches and strategies should be used for people with different needs, abilities and circumstances.

Further research is needed in some areas, to determine the effectiveness of interventions for people with low enablement and in special needs and vulnerable groups.The evidence for consumer enablement continues to evolve, but this guide presents approaches that are best supported by evidence at the current time.

References

  1. Based on Australian Institute of Health and Welfare figures (2015) for the following chronic diseases: arthritis, asthma, back problems, cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental health conditions.
  2. Australian Institute of Health and Welfare.1 in 5 Australians affected by multiple chronic diseases. Canberra: AIHW; 2015 [updated 2017 Oct 18; cited 2018 Jan 15].
  3. Boxall A. Explainer: what is Medicare and how does it work? Parkville, Vic: The Conversation; 2014 [updated 2014 Jan 31; cited 2018 Jan 15].
  4. Boxall A-M, Gillespie JA. Making Medicare: the politics of universal health care in Australia. Sydney: NewSouth Publishing; 2013.