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

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?

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

Mark james

Organisation
N/a
Comment date
03 November 2017

I can see how this might challenge the medical model, of we do 'this' to you, but I wonder about the possibility of such a measure, or future version X, being used for nefarious purposes. The response then might be, as bartleby would pit it, "i would prefer not to".

Deborah

Position
Occupational Therapist,
Organisation
Nhs
Comment date
03 October 2018

Yes there is a charge for the licence. This can be obtained from Insignia Health website.

Ernest Stream

Position
Road sweeper,
Organisation
Road Clean.
Comment date
24 June 2019

Gosh -that's not very helpful.

Sheila Byrne

Position
Director,
Organisation
Hope St Holistic Mental Health and Wellbeing Support Group
Comment date
20 October 2019

Feedback from our members indicate that what we are providing is more beneficial as it’s a living approach and supports from a holistic approach which meets all needs from the hierarchy of needs.

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