How Generational Factors Impact Patient Engagement

Over the last several years, timeline definitions of generations have changed—Baby Boomers were once classified as those born through 1964 instead of today’s 1960—but one fact remains the same: There’s a definite gap between generations’ approach to healthcare.

To explore generational influences to patient perspectives on their engagement, Medscape Education surveyed more than 5,000 patients and nearly 1,000 physicians, and revealed the results at the 2016 HIMSS Conference in Las Vegas.

The presentation, which encompassed two years’ worth of data, provides clinicians, CMOs and CIOs deep insights into factors that can both facilitate and identify barriers to realizing deeper levels of patient engagement. The study came about when healthcare providers discovered that patient portals were being used to a lesser extent than anticipated. Younger patients weren’t buying into them, yet older patients were surprisingly good about following instructions to gain access to their patient portal.

“The first ‘a-ha’ moment was asking a question about their approach to healthcare, such as ‘Do you use the internet to research health information?’ It’s a simple question that could easily identify how digital literacy can be used in a helpful way in the clinical encounter in the older population, if their approach was fully understood,” says Chris Hoffman, a presenter and vice president of quality and strategy for Medscape Education. “Don’t assume that because somebody has gray hair, they aren’t online gathering information.”

Insights gleaned from the study include the impact of a patient’s generational representation to needs for clinician behavior; impact of the physician’s generational group to their behaviors and beliefs around patient engagement; and comparison of the synchrony and asynchrony of generational portrayal of patients and physicians to the goal of patient engagement.

“Some generations do what they’re told because it’s how they were raised,” explains Hoffman.

How the Archetypes Stack Up

In a nutshell, the Silent Generation (ages 74 and older) is more likely to follow doctor’s orders. Baby Boomers (ages 56–73) are more likely to debate with their doctor. Gen Xers (ages 35–55) are more likely to get privately educated before visiting a physician. And millennials (ages 16–34) are more apt to look for all types of connected healthcare.

Here’s why it’s important for physicians to understand the generational differences:

• Meaningful Use incentives are being left on the table.

• Engagement tools are untapped by the Silent Generation and millennials.

• A greater percentage of all generations uses the internet more often than previously considered as a source of information to help manage their health.

• Healthcare providers could facilitate post-visit and between-visit support by recommending online resources.

• And, perhaps surprisingly, millennials are statistically less likely to use technology tools than other generations.

On a broader level, here’s how the generational archetypes stack up:

The Silent Generation—The Silent Generation (born prior to 1942), often called the “Greatest Generation,” relies on doctors to provide medical care direction. They’re prepared to defer researched information to their physician’s opinion. Their clinical visits are more frequent and longer due to clinical acuity and patient preferences centered on their medical care. They have firm beliefs in good service, having grown up during a time when “the customer is always right.” They consider only doctors and nurses as healthcare professionals.

“The Silent Generation is shown to explicitly trust their physicians,” says Jaime DeMaria, PhD, also a presenter and senior vice president for Medscape. “They’re the most confident generation in shared decision-making and patient engagement. While they represent digital immigrants, they’ll register for portals if recommended by their physician, but their use beyond lab data review is limited.”

Baby Boomers—Baby Boomers (born between 1943 and 1960) want to be engaged in their medical care. They seek counsel from their physician, often asking his or her opinion on researched material for specific care. They also only consider physicians and nurses as healthcare professionals. They have a keen interest in quality, as evidenced by their use of third-party comparisons to self-direct to specialists and providers. Many Boomers are involved in decision-making for their aging parents’ medical care while concurrently doing the same for their children. Because of dealing with three generations and voluminous data, Boomers may inadvertently cause the most communication challenges for physicians.

“Boomers are shown to respond most to a physician’s verbal instruction, followed by written and then internet communications,” explains DeMaria. “Physicians can best help Boomers by recommending reliable resources. This generation is moderately confident in shared decision-making and patient engagement. Physicians generally don’t recommend portals to this group.”

Generation X—Generation X (born between 1961 and 1981) wants to be engaged and educated. Relatively healthy, they’re notably curious and actively seek information. They assume healthcare providers and their staff are knowledgeable. They’re less likely to be loyal to a certain provider. They’re more likely to switch physicians and hospitals based on their most recent experience, not their overall past experience. 

“Generation X is shown to respond the most to a physician’s verbal instructions, also followed by written and internet communication,” says DeMaria. “Doctors can best help by recommending reliable resources.”

Doctors don’t recommend portals for this generation. However, when they do use portals, it’s primarily for lab results (77%), communication with their healthcare provider and scheduling (41%), and medication refills (37%).

Millennials—Millennials (born between 1982 and 2000) want to be connected. They access the health system through primary care providers (PCPs), urgent care centers and OB/GYNs. They have a low use of inpatient and outpatient services, but when used they typically come through the emergency department or maternity. They use and appreciate technology, have a positive personal relationship with their physician and value health information from multiple sources. If they lose confidence in the care provided in their most recent experience, they’re more likely to switch physicians or hospitals.

“Millennials represent the most likely group to respond to a physician’s verbal instructions,” says DeMaria. “However, they’re less comfortable asking questions and discussing concerns. This generation is minimally confident in shared decision-making and engagement actions. Doctors recommend the portal to millennials less often than other groups.”

On the provider side, doctors view patient engagement as essential, yet younger doctors find it more challenging than older ones, says Hoffman. Also, Boomer doctors are nearly twice as likely as Silent Generation ones to recommend apps to their patients.

The survey showed a gap on the providers’ side concerning the use of patient portals, providing an opportunity for healthcare providers to extend that clinical visit into the everyday lives of patients.

“A takeaway message from our survey is that healthcare providers need to help equip patients across generations with the skill set for shared decision-making concerning their health,” according to Hoffman. “The more we can do to arm patients with that information, the better off the healthcare system and the health of the country and the population are going to be.”