WBB's Thought Leadership

Patient Self-Management

October 3

Higher patient activation rates result in lower rates of healthcare utilization.

WBB Take:
Patient Activation Measures (PAM) are a key component in improving patient care and reducing healthcare costs. Due to the increasing number of patients with chronic conditions it is necessary for physicians and providers to ensure their patients are competent in understanding their healthcare needs.
Activated patients are better engaged in the ongoing management of their conditions, resulting in less clinical demand, and better care coordination. Activated patients are less likely to utilize high-cost emergency care services, due to their attendance and engagement at general practice and outpatient appointments.

The rising demand for healthcare services has resulted in reduced access to resources. By increasing patient’s ability to manage their own health, healthcare systems will have more engaged patients, less strain on resources, and reduced costs. PAM questionnaires will allow providers to tailor their care to individual patient needs. The 1-4 Levels provided in the PAM questionnaire enable providers to identify their patients’ level of understanding, making it easier to address concerns and gaps.    

Cited by Stephanie Owusu, Julia Davis, and Matthew Loxton

Excerpt: “Improving outcomes for the growing number of people living with long-term conditions, while managing a rising demand for health services, is a challenge faced both by physicians and policymakers across health systems in developed countries. Such patients use the majority of healthcare services, with 70% of National Health Service (NHS) spending being for patients with long-term conditions. However, these patients are often expected to manage their conditions at home for much of their lives, spending under 1% of their time in contact with health professionals. It has been long recognised that self-management should form an important part of any model of care for those living with long-term conditions. More recently, the importance of self-management in reducing demand for services has been recognised as part of the NHS 5-year forward view, and is a central pillar of prominent initiatives such as the accountable care organisations and some patient-centred medical homes.”

“In this study, we exploit a unique database of over 12 000 patient activation scores linked to longitudinal data on the utilisation of primary and secondary care within an urban health economy (Islington Clinical Commissioning Group (CCG)). This is the only PAM pilot site, in the English NHS, which surveyed self-management capability from all patients with long-term conditions. Controlling for patient demographics and clinical characteristics, and multiple responses per patient, we quantify the association between patient activation and the frequency with which these patients access primary and secondary care. Further, we examine the rate at which patients experience 30-day emergency readmissions to hospital, and their length of stay for elective and emergency admissions to hospital. We then examine the association with wasteful utilisation, which we define as ‘did not attends’ with general practitioners and outpatient specialists, and self-referrals to emergency departments for conditions classified as minor severity.”

“Our findings suggest that patients’ ability to manage their own health and healthcare is inversely related to primary and secondary care utilisation and inefficient utilisation. This underlines the importance of promoting self-management capability, especially when services have rising demand for care and constrained resources. Broadly, there are two main strategies that clinicians and commissioners could take in response to our findings for managing patients with long-term conditions: either intervening to improve the self-management capability of their patients, or adapting the approach they take to delivering a patient’s care to the level of ability of the patient.”

Source: BMJ Quality & Safety




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