Promoting patient involvement: educational, organizational, and environmental strategies.

The chronic nature of disease in the late 20th century, the issues of health resource constraint, and substantial ethical concerns associated with high technology medical care require the identification of efficient and effective ways to involve patients and families in ongoing health decision making and self-management. While only a limited number of comprehensive approaches have been identified, a wide range of more limited interventions by hospitals and other health care providers suggest the practicality of these strategies. Although the research base is weak with regard to the combination of the interventions, more evidence suggests the value of such strategies as changes in the physical environments of health care institutions, interventions to promote a healthier organizational culture, changes in the care delivery process, increasing patient/family responsibility for care delivery, and helping patients adapt regimens to their own lifestyles.