Supporting people to manage their health: An introduction to patient activation

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With 60 to 70 per cent of premature deaths caused by detrimental health behaviours, it is vital that people engage more with improving their own health. This paper introduces a way of conceptualising and measuring that engagement known as 'patient activation'.

Patient activation can be used to reduce health inequalities and deliver improved outcomes, better quality care and lower costs. Drawing on US and UK-based evidence, the paper describes the robust patient-reported measure – the PAM – used to gauge patient activation. PAM measures an individual's knowledge, skill, and confidence for self-management.  Research shows that appropriately designed interventions can increase patients’ levels of activation, with associated health benefits. The paper explores how this is being achieved in practice and offers recommendations for extending early use of the PAM in the United Kingdom.

Key findings

  • Patient activation is a better predictor of health outcomes than known socio-demographic factors such as ethnicity and age.
  • 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.

Policy implications

  • Used in population segmentation and risk stratification, patient activation can provide new insights into risk that go beyond those using traditional socio-demographic factors.
  • The PAM provides a simple, evidence-based mechanism for establishing the capacity of individuals to manage their health – and then using that information to optimise the delivery of care. 
  • Given the links between low levels of activation and poor health outcomes, the role of the PAM in addressing health inequalities in the United Kingdom should be considered further.
  • It would be beneficial if the Department of Health and NHS England echoed calls for use of patient activation in England.

Read Judith Hibbard's blog: How do people become good managers of their own health? 

Comments

Eugene Hammond

Position
Retired,
Organisation
KGH
Comment date
17 May 2014
I think this a great idea. Indeed any scheme that actively attempts to draw the patient intellectually and practically into the activity and flow of their healthcare can only be positive. However, there are two sides to this, the Patient and their Practitioners. So what do you do in my recent visit to a practice nurse? My GP has suggested I keep regular checks on my BP, which I now do. Noticing an abnormal pattern with large swings from too low to high I made an appointment with a nurse. The nurse was disinterested, almost tore up my data sheet before I asked for it back. She measured my BP, said it was OK and further told me to stop measuring and said if I needed to know my BP I should ask her to measure it!
The consequences of this are you don't visit that nurse again, you doubt yourself and might even be reluctant to bring information to a, so called, "professional".

Keep up the good work.

Giri Rajaratnam

Position
Deputy Regional Director, PHE Midlands and east,
Organisation
PHE
Comment date
19 May 2014
A good report. However, i found the section on how to improve PAM insufficiently detailed. Has there been a systematic review on this?
Giri

Helen Gilburt

Position
Fellow, Health Policy,
Organisation
The King's Fund
Comment date
20 May 2014
The report is an introduction to patient activation and the measure. With over 140 papers published on this, it was impossible to provide comprehensive detail in all areas. In practice the PAM it is not an intervention in itself but a tool to support the tailoring and delivery of interventions to 'meet people where they are'. There have been a number of randomised controlled trials using PAM to tailor interventions but I am not aware of any systematic reviews to date.

Karen Rockell

Position
Living,
Organisation
SCAD Survivors
Comment date
20 May 2014
Interesting report - below is an example of patients activating themselves through social media.
SCAD survivors are a closed Facebook group, made up of people who have survived a rare form of heart disease call Spontaneous Coronary Artery Dissection (SCAD). This condition is rare and little is written about it academically and nothing useful is available to the people who have had one Because of this, a woman in America started a Facebook page looking for others to help her, share her experience, ask about treatments, management and long-term prospect etc. Amazingly in 3 years the group has grown to 578 people across the globe. They have all had at least one SCAD some have had more.
A number of this group are from the UK. Together we have persuaded a Cardiologist to undertake research into SCAD with the hope of finding answers to some of our questions and obtaining informed views of long-term management. A SCAD is not caused by "normal heart disease related lifestyle issues" such as smoking, weight, exercise, cholesterol etc. To date cardiologists can only guess as to why it happens to seemingly healthy people (often young women postpartum). As individuals we wanted answers and were frustrated by the lack of any. Together through social media we have a voice and influence and with funding from the British Heart Foundation we now have hope.

Paul Munim

Comment date
25 May 2014
We believe in order to make this work there has to be involvement from local voluntary and community organisations. We have created a website http://www.useyourcommunity.com which is about enabling people to find their local community organisations and connect with them for services and support. We believe that GPs and other professionals should link patients up with local organisations so that support to patients can be maintained. In our experience, it is the patients that cost the NHS the most in medication that are least likely to take part in their care because they have no understanding or support. Local organisations are critical because they can provide local and consistent support to patients

mike kirk

Position
Consultant to ABI PROVIDER OF REHAB,
Comment date
27 May 2014
This will not work for people with an ABI whose major problems are not managing their health but rather their social and behavioural problems.
Governments have totally failed to implement the Select Committee recc of 2001 for people with LTC and head injury. Mental health services are being cut whilst guff emits from DH about choice of service for users. The word for these policy initiatives is simple: cant.

Barry Roberts

Position
Director of Innovation and Sales,
Organisation
Turning Point
Comment date
28 May 2014
Turning Point are currently delivering a pilot service to support people with Long Term Conditions to better self-manage. The service is commissioned by Bradford City and Bradford District CCGs. The aim of the service is to support patients with low levels of activation to increase their confidence and capacity so that they become more "activated". We are using the Australian Health Education Impact Questionnaire (heiQ) to provide a measure of activation at commencment of engagement with the service and then at completion. The heiQ measures activation by scoring patient responses in 8 domains, a richer picture than PAM, we believe.

Phillip Bennet…

Position
GP,
Organisation
Aberfeldy Practice, Tower Hamlets
Comment date
28 May 2014
Fascinating subject and a really interesting set of presentations. Do you have the slides available - particualry interested in the charts showing uptake of care related to PAM status.

Lynne

Comment date
03 June 2014
It looks great - a tool to use for Making every contact count but it also carries a hefty price tag

Helen Gilburt

Position
Fellow, Health Policy,
Organisation
The King's Fund
Comment date
20 June 2014
It's great to see so many people interested in this area. In terms of patient activation, it is one element in the wider arena of patient involvement. Although it is tempting to think of lots of activities of involvement as 'activating' in practice patient activation is a specific concept, that captures a person's self concept of themselves as having the requisite knowledge, skills and confidence to manage their health. The strength of patient activation is that it has been robustly related to health outcomes as well as behaviours over up to 18 months post intervention.

Fiona Day

Position
public health consultant,
Organisation
leeds city council
Comment date
02 July 2014
great report, where is the actual scale and is there a charge to use it in practice?

Annette Thom

Position
Public Health Student,
Organisation
University of Newcastle, Australia
Comment date
06 August 2014
It is a very compelling report and the potential to apply the PAM in the NHS is clear. I have two questions:
1. What costs would be associated with using the privately licenced PAM?
2. What alternative measures are available?

bridesmaid dresses

Position
bridesmaid dresses,
Organisation
bridesmaid dresses
Comment date
29 January 2015

joanna

Comment date
12 February 2015
Interested in using PAM but unable to find out if there is a charge for the licience . Can anyone help with this ?

Dr Kadiyali M …

Position
Retired GP,
Organisation
7iMed
Comment date
21 February 2015
I find this interesting but not good enough because the authours continue to give importance to theoretical idealism and looks as if they have not understood the practical reality of offering comprehensive healthcare solutions. To improve patients persuption we (doctors) must give importance to foundation on which the castle of modern medicine.

Kadiyali Srivatsa

Position
Retired GP,
Organisation
7iMed
Comment date
21 February 2015
I have collected data, compiled a list of common symptoms and developed a tool called MAYA (Medical Advice You Access) This was designed to help reduce patients access emergency care. The reason I developed this tool was to help reduce cross infections and antibiotic use. Standardisation of healthcare is a must to help move forward.

Stephanie Collins

Position
Hospital and Community Services Manager,
Organisation
Age UK Hillingdon
Comment date
02 March 2016
I am trying to source some training for my staff who will shortly be using this tool. Does anyone know where I can get this?

Thanks

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