[Does patient knowledge improve treatment outcome?].

Non-compliance in patients is rarely provoked by intention or laziness. Thus, patients should not be the first to be blamed for lack of therapeutic success. Non-compliance from health care providers to supply patients with necessary information and skills, though, is an important cause of insufficient treatment outcomes. Patient knowledge can improve health outcomes. But this knowledge must be evidence-based and relevant for the patient. In addition, knowledge must enable patients to assume an important part in disease control and treatment. Evaluation of patient information or self-management programmes should consider that knowledge is just one component of a complex intervention. Self-management programmes for type 1 diabetes or severe asthma are examples of where patient knowledge as part of a complex intervention may lead to substantially improved treatment outcomes. Disease-unspecific self-management programmes like the expert patient programme do not lead to important changes of relevant outcome measures. Patients and consumers want to participate in medical decision-making. However, there is a lack of evidence-based patient information for most indications. Informed decision-making by patients may lead to intelligent non-compliance and worsening of treatment outcome according to conventional assessment criteria. Direct-to-consumer advertising (DTCA) hits a public that lacks competencies in critical health literacy. Critical health literacy which combines the concept of evidence-based medicine and health literacy should be integrated into existing school curricula.