Within the general population some people actively focus on reaching and maintaining good health, while others are more passive about the whole thing. So what makes the difference?
Is learning to manage your health like learning a country's geography – where all you probably need are a list of facts and a good reference guide? Or, is it more like learning to swim – where facts and a reference guide would be of limited value? In this instance you need to acquire basic skills – like putting your face in the water and learning to float – but you must also practise to gain confidence before advancing to the next step.
Not surprisingly, as our new paper, Supporting people to manage their own health, reports, becoming a good manager of one's health is more like learning to swim: here too you must learn some basic skills, and gain confidence before you can start to take on all of the challenges. However, many health care providers currently treat the process more like a geography lesson; giving patients some key facts and a reference guide, rather than starting from the skills the individual has and helping them to gain further skills and confidence to progress.
More innovative health care systems are beginning to take into account how engaged people are in managing their own health and to help them move forward from this point. It is now possible to accurately assess 'where patients are' in terms of their knowledge, skill, and confidence for managing their health using the patient activation measure (PAM). This is a simple 10- or 13-item survey that people can answer themselves. It has a 0–100 score, indicating how engaged – or activated – an individual is – from being passive about their health to being very proactive.
The PAM is being used in clinical settings to: assess where patients are so that health care teams are better able to tailor care plans for that individual patient; enable clinicians and providers to evaluate progress; and help them measure when patients or whole patient populations are improving their ability to manage their health. This last point is important to help us assess the quality of care. If patients are getting high-quality health care, they should be getting better at managing their own health too. We can now measure this, and in doing so we will shine a light on this critical area of care, enabling us to know what is working, and which delivery systems and clinicians are effective in helping patients gain the skills and confidence for self-management.
Research shows that patients can make gains in their activation level, and these gains translate into more positive health behaviours and improved outcomes. More activated patients also have lower health care costs, largely because they are hospitalised less often and are less frequent users of the accident and emergency departments.
In health care we measure what matters. What the patient brings to the care process may be the most important element of all. By measuring patient activation, and using the information in the design of care, we can finally bring this missing element in the health care equation.
This blog is also featured on the British Medical Journal website.
Comments
However, I am less sure about the claim that such an approach may lead to a reduction in health inequalities. Such a claim suggests a lack of appreciation of the determinants of health and the complexity of inequalities.
People who engage with patient activation are already motivated, interested and have an "internal locus of control". These are people who are likely to have better economic circumstances and who are already more likely to experience better health outcomes. Those who already have poorer health, lack in confidence and a belief in their own self-efficacy or mastery are those who are less likely to engage in such a programme. This is generally the group of people who alreday experience a range of inequalities, including poorer health outcomes. I suggest that such programmes create a risk of increasing health inequalities as those who are more able to take up the opportunities for self-management do so, resulting in an increasing gap.
This sounds like the sort of programme that requires an inequalities impact assessment, followed by consideration of the application of proportionate universalism.
I have been offered medication which I should not take, even when in hospital with pneumonia. I don't think that some medics inspect our medical records when being assessed. In hospital patients requests are forgotten. I have observed and heard that some doctors are not listening, which disturbs patients.
In my case, I have quite a few medical conditions, and everyone tells me how amazing I am, but I disagree with them. It is a case of mind over matter. Most of the time I get head tremors, severe head pains, which affect my balance, but I will still force myself to go out. I have had 9 full strokes and get regular TIA's, sometimes collapsing and finding myself in hospital 2 hours later. I have collapsed 8 times with strokes so when I get symptoms I do worry a little. Even so I carried on with my 5 different dance classes until after my 5th stroke, when I was physically incapable, and how I grieve over that!
It is really the age old case of taking each day as it comes and look for something to smile about, to try to be content. Life is as it comes...
Perhaps we shouldn't confuse patient activation with self-management,however as I am a believer in utilising what is already out there in real life and is evidenced to use, I would like to draw the King's Fund attention to a NHS owned resource for cardiac patients in use in many areas (throughout the UK) since 1992.
The Heart Manual www.theheartmanual.com
Built on a CBT model and using an individual based tailored approach,the resource meets the needs of 16,000+ patients per annum.This is a supported self management programme,facilitated by specially trained health professionals,That is the key. Whatever the resource, be it on patient activation or/and self managment the tool is only as good as the person who is skilled up/competent to deliver, introduce and support this type of journey with the patient.
(I would be happy to fw a copy to a named person within the Kings Fund-if provide me some details please).
With best wishes
Louise
Why is this? Lack of time with the patient, lack of training in the skills needed to be alongside someone rather than imparting information? As so much research shows that even small steps can have beneficial health effects in conditions like obesity and Type 2 diabetes, it makes sense to equip health professionals to 'start from the skills the individual has and help them to gain further skills and confidence to progress.'
People who are more activated are significantly more likely to attend screenings, check-ups and immunisations, to adopt positive behaviours (eg, diet and exercise), and have clinical indicators in the normal range (body mass index, blood sugar levels (A1c), blood pressure and cholesterol).
Patients who are less activated are significantly less likely to prepare questions for a medical visit, know about treatment guidelines or be persistent in clarifying advice.
Patient activation scores and cost correlations show less-activated patients have costs approximately 8 per cent higher than more-activated patients in the baseline year, and 21 per cent higher in the subsequent year.
Studies of interventions to improve activation show that patients who start with the lowest activation scores tend to increase their scores the most, suggesting that effective interventions can help engage even the most disengaged.
People become good managers of their own health in different ways and that has to do with the level of education i.e if you can read or write to start with.
Learning to manage some ones health is like a Sport man and woman who is going for a competition and wanted to excel need to know what to eat and at the right time.
How to do his or her exercise at the right time.
A good health is about eating good food and doing exercises all at the right time
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