Patient Activation & Readiness to Change Starts with Confidence

Posted April 24, 2017

Patient activation is a person’s ability to manage their health and overall health care.

Today’s Patient Activation Measure score, also simply called PAM, was created in order to assess a patient’s knowledge, skill and confidence in taking care of their own health (1). Health planners, care stakeholders, employers and policy makers are increasingly concerned with the ability to engage with consumers, which also means they’ve been paying more attention to the idea of the PAM score in recent years.

Measuring Patient Activation Today

Less than half of the adult population today is at the highest level of activation with their health, this according to a study by the Center for Studying Health System Change, also known as HSC (1).

Someone with a high degree of engagement is a person that is more likely to obtain preventative care and to take other steps in an effort to monitor their health. These are also people who would be more likely to maintain a healthy diet, exercise, and have an increased likelihood of adhering to treatment protocols given by their health care professionals. They are in a category of people more likely to ask questions of their care team/providers so that they can be as informed as possible in areas surrounding their health. And even among those with the highest engagement with their health, they indicate that they still struggle to maintain healthy behaviors.

What are the major differences between those who are highly engaged with their own health, and those that are not engaged with their own health?

Those who are less engaged indicate they lack skills and confidence to manage their health when compared with those identified as more engaged with their health.

The National Patient Safety Foundation’s Lucian Leape Institute Report of the Roundtable on Consumer Engagement in Patient Safety writes about this argument, saying:

In spite of the pervasive reference to consumer and patient engagement among health care professionals and advocates, the vast majority of Americans remain relatively uninformed and passive recipients of health care services and thus lack the confidence and skills needed to fully engage in their health care…(2)

Those with these lowest levels of engagement include Medicaid enrollees, poor self-reported health, low incomes and less education. Those with higher activation scores, not surprisingly, also are a group of people more likely to have greater support from health care providers for self-management of chronic conditions (1).

Daily management of our health directly impacts health care utilization, costs and eventual patient outcomes.

This means engagement impacts both “sides” of the care equation: the provider and patient are both negatively impacted when a person lacks confidence and the tools to help her succeed.

Case in point: 33 to 69 percent of medication-related hospital admissions are due to poor medication adherence. In many cases of medication non-adherence, people report not having the resources to self-manage their medication. Better medication adherence, on the other hand, has even been associated in large cohort studies with decreased mortality among patients after heart attack and among patients with diabetes (3).

medication adherence medacheck iOS and tablet reminderBut research has also suggested that activation levels are not set in stone (1). In fact, they are actually in flux—a factor that care teams can take advantage of to improve patient outcomes—and patient confidence.

The PAM phases that patients are in, also referred to as levels, are useful for clinicians as the work to effectively design appropriate interventions for people, tailored to their specific needs at that stage of “readiness.”

For example, if someone has been recently diagnosed with Type 2 diabetes, but they lack self-reported skills, confidence, and are in an under-served area for health care services, we can know that a more vigorous support plan needs to be in place for them. Recognizing more about a patient than just their diagnosis actually helps physicians evaluate, listen, and more effectively work with any given person to give them proper tools to help them gain a sense of control over a new set of behaviors they will be asked to take on.

Progressive support programs, including MedaCheck, help communication, and improve education. MedaCheck’s reminder system overcomes some of the common, avoidable reasons for non-adherence. Knowing that the concept of activation reflects the degree to which a person feels they can impact and be “in charge” of their health further supports the idea that tools and support programs can help them gain that sense of control.

Physicians and care team members are tasked with being a community advocate: an advocate for the health of entire neighborhoods, and also for helping people on an individual basis. If the majority of people in many of our communities do not have the tools or confidence to proactive work towards a higher level of “readiness,” it’s time we give them interventions that are reliable, proven and give them better access to care.