Measuring knowledge, skills and confidence to self manage.

Patient Activation

Dr Alf CollinsClinical Associate in Person Centred Care

The Health Foundation

Self management is usual care

Hours with NHS / social care professional = 5-10 in a year

Self management = 8750-55 in a year

So

The system should work in partnership with people with LTCs in order to support them to develop the knowledge, skills and confidence to self manage

Supporting the partnership to work

What makes a good partnership?

Partnership in healthcare

10% of population

30% of population

40% of the population has low or no confidence to self manage

People at low levels of activation tend to:

• Feel overwhelmed with the task of managing their health

• Have low confidence in their ability to have a positive impact on their health

• Not understand their role in the care process• Have limited problem solving skills• Have had a great deal of experience with failure in

trying to manage, and have become passive with regard to their health

• Say they would rather not think about their health

As compared to people at low levels of activation, people at higher levels tend to:

• ‘Be engaged’– Come prepared– Ask questions– Make decisions– Have less unmet needs (nb inequalities)

• Have improved clinical outcomes (including mental health)

• Enjoy an improved quality of life • Use less healthcare resource• Feel satisfied at workWhy Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Jessica Greene and Judith H. Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011

Uses of patient activation measure

Segmentation• Target resources• Use resources

more effectively

Tailored coaching• Start where

people are• Personalise

support

Programme assessment• Quality assure

interventions• Improve quality of

interventions

Predictive modelling• More

sophisticated understanding of drivers of risk

People with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’

‘Scores’

Activation as a primary mediator of other indicators.

Activation

Clinical outcomes, including mental

health

Improved QOL, wellbeing

Higher rate of retention at work

Feeling in control

More independent

Lower utilisation of health and social

care resource

Tailored interventions- including health coaching- can support people on their journey of activation

Thus tailored interventions improve all other ‘downstream’ indicators

The national learning set: using the concept and the PAM at scale

5 CCGs plus renal registry150,000 patients over 2 years

• Learning plus rigorous evaluation– Pragmatics– Face validity– ‘Coaching for activation’– Collaborative care and support planning– Understanding population health and reducing

inequalities

Questions and challenges

• Concept or measure or both?• PAM as an outcome?• Personal outcomes• Social model of health

http://www.kingsfund.org.uk/publications/supporting-people-manage-their-health