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Enablement was also associated with patients' self-reported general health over the last 12 months; patients with poorer long-term health reported less enablement at consultation.
In the UK patients of lower socioeconomic status gain less enablement from consultations [ 32] especially if the clinical issues are complex [ 33] and in the USA greater dissatisfaction with health care amongst low-income patients has been reported with such patients feeling not listened to and 'brushed off by physicians [ 34].
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In addition, in areas of high deprivation the inverse care law continues to exist, leading to shorter consultations, less patient enablement and higher GP stress [ 26, 27].
Perhaps patients with a stronger internal health locus of control and better self-management 'ask' less for enablement, so that they do not need help in general practice regarding the aspects covered by PACIC.
If so, enablement would be less likely to track fulfilment of prior 'service outcome' expectations and more likely to track relevant features of consultation quality, and would offer a means of assessing the quality of a consultation that stands separate from a 'demand & supply' model of service provision.
If we assume that the patient answers PEI questions literally, then they should answer each enablement question as "same or less"; in other words giving an overall PEI score of zero.
23 In Scotland, Mercer and Watt 3 found an increased burden of ill health and multimorbidity in deprived areas, resulting in greater demands on primary healthcare leading to reduced access, less patient doctor time and more general practitioner (GP) stress but less patient enablement.
The distinctiveness between satisfaction and enablement observed in that same study implies that patients can be enabled but not satisfied, by (for example) being less than fully satisfied by outcomes of a consultation (which didn't fulfil their expectations), yet still benefited by it as captured by enablement.
Key to the current discussion is that enablement purports to give a representation of consultation quality that is less influenced by non-clinical factors, for example patient reluctance to express dissatisfaction about clinicians with whom they have an on-going relationship, or any tendency to express dissatisfaction purely on the basis of whether or not prior expectations for referrals (etc).
In areas of high deprivation such as the West of Scotland we have recently reported lower patient enablement in patients with psychological distress in high deprivation areas compared with less deprived areas [ 16].
Another project that enables the interconnection of multiple sensor networks is Sensor Web Enablement [30].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com