How to Facilitate Patient Engagement in Otolaryngology

Patient engagement has become something of a buzzword in clinical care, a phrase increasingly used over the past decade to basically describe getting patients involved in their own care to improve health outcomes. Like the phrase “evidence-based medicine” years ago or, more recently, “big data,” the phrase “patient engagement” has entered the clinical lexicon with some ease, but its full meaning continues to unfurl with a deeper understanding of what engaging patients in their own care looks like and how this is distinguished from other patient-centered foci such as “patient satisfaction” and “patient experience.”

In 2019, Marisa A. Ryan MD, MPH, and Emily F. Boss, MD, MPH, gave some flesh to this phrase in an article entitled “Patient Engagement in Otolaryngology,” (Otolaryngol Clin North Amer. 2019;52:23-33) in which they discuss important ways to promote patient engagement through information technology (e.g., patient portals for access to prescribed medications, appointments), patient-centered communication (e.g., using clear, jargon-free language), and shared decision-making (e.g., incorporating patient/family preferences and values) and the subsequent improvement these measures can have on patient safety. Senior author Dr. Boss, professor in the departments of otolaryngology–head and neck surgery, pediatrics, and health policy & management at Johns Hopkins University School of Medicine and the Bloomberg School of Public Health in Baltimore, emphasized that “the more engaged patients are in their care, the more they trust their clinicians, perceive respect from their clinicians, and adhere to treatment plans, which, in turn, improves outcomes and reduces attrition and loss to follow-up.”

Facilitating patient engagement can take many forms. Among them is the use of phone-based technologies that can make it easier for patients and providers to communicate on a variety of issues, ranging from routine setting up for and reminding patients of clinical visits to more novel uses that facilitate intervention for specific conditions.

Phone-Based Technologies in Otolaryngology

In a recent review of smartphone applications (apps), Eleonora M.C. Trecca, MD, an otolaryngologist in the Department of Otolaryngology–Head and Neck Surgery, Research Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy, and her colleagues systematically reviewed apps used in otolaryngology for screening, early diagnosis, and management of their otolaryngologic conditions (Ann Otol Rhinol Laryngol. 2021;130:78-91). A total of 1,074 otolaryngologic apps were found through a search of the Google Play Store, Apple App Store, and PubMed. Table 1 lists the apps grouped by their use per subspecialty.

Given the ubiquity of smartphones and the increasing availability and use of apps for otolaryngologic conditions, Dr. Trecca, lead author of the study, thinks otolaryngologists need proper training in how to choose and use these apps. Training is particularly needed, she said, because of the high variability in the quality of these apps, most of which are developed without help from healthcare professionals or scientific societies.

A main limitation of these apps, as found in the study, is the lack of validation by clinical trials. In addition, most apps receive only minimal regulation by the Food and Drug Administration because regulation applies only to apps categorized as “medical” and not to those categorized as “lifestyle.” Dr. Trecca also cautioned against viewing popular or widely used apps as a criterion for quality, as the study found that higher-quality apps often received fewer reviews and downloads than popular, but low-quality, apps.