What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs

Health Affairs (Impact Factor: 4.97). 02/2013; 32(2):207-14. DOI: 10.1377/hlthaff.2012.1061
Source: PubMed


Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual's level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients' role in managing their health care can contribute to improved outcomes and that patient activation can-and should-be measured as an intermediate outcome of care that is linked to improved outcomes.

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Available from: Judith Hibbard,
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    • "Patient activation specifies the level of patients' engagement [1] [2] and may contribute to better self-management [3], higher engagement in treatment [2] [3], and greater patient satisfaction [4] [5]. Patient activation is in addition associated with better health outcomes [2]. The Patient Activation Measure-13 (PAM-13), developed by Hibbard et al. [4] from the 22-item version [1], ascertains health engagement and thereby self-reported knowledge, skills, behaviours and confidence for self-management of health and chronic diseases. "
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    ABSTRACT: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51). The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). PAM has appropriate and acceptable psychometric properties in mental health settings. Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Patient Education and Counseling 06/2015; 39(11). DOI:10.1016/j.pec.2015.06.009 · 2.20 Impact Factor
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    • "Delivering evidence-based medical services of high quality, consistent with the patient's medical needs and in a way that fosters doctor–patient partnership and shared decision making, are qualities strived for in all Western health care systems (Hibbard and Greene, 2013). These objectives are promoted through health policy initiatives, but the decisive factor for success is found at the end of the line, in the meeting between patient and doctor. "
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    ABSTRACT: Bodily conditions that are difficult to identify, explain and treat with the aid of medical knowledge and technology appear to be particularly challenging to medical encounters. Patients are often dissatisfied with the help they receive, and they often experience that their medical needs are not met. To explore factors facilitating patient satisfaction among patients with a medically unexplained condition, we ask: what is the importance of individual versus relational factors in facilitating patient satisfaction in clinical encounters between general practitioners (GPs) and women with medically unexplained long-term fatigue? We approach this question through a statistical analysis of survey data collected from a net sample of 431 women recruited through a patient organisation for people suffering from myalgic encephalomyelitis in 2013. Participants were asked about their experiences with general practitioners in the Norwegian national health system in two different phases: shortly after illness onset, and current regular general practitioner last 12 months. The questions evolved around themes concerning shared understanding and decision making, being taken seriously, being paid due respect and being treated as an equal partner. Through descriptive statistics and multivariable logistic regression analyses, we explored how their experiences were related to individual and relational factors, respectively. Free-text comments from the questionnaires were used while interpreting the results. The analysis illuminates that relational aspects in medical encounters between GPs and ME patients, especially continuity, congruence in doctor-patient views and being seen by a specialist, are important catalysts of patient satisfaction. The probability of being satisfied with the initial investigation was more than six times higher in women who were referred to specialists, compared to those who were not. We conclude that continuity of care and experiences of being in a partnership that operates on a common ground - a shared understanding of the patient's illness - foster patient satisfaction among women with medically unexplained long-term fatigue. © The Author(s) 2015.
    Health 05/2015; DOI:10.1177/1363459315583158 · 2.10 Impact Factor
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    • "The study of Hibbard and Greene (2013) also suggests that it is possible to influence patients to become more active. In contrast to active patients, less active patients are associated with higher costs of health care (Hibbard et al., 2013). Many of the proponents of increasing the amount of personal responsibility taken by patients see the patient access to their medical records as a significant precondition of the anticipated healthcare revolution (e.g., Munir & Boaden, 2001; Sittig, 2002; Joubert et al., 2007; Gaunt, 2009; Hoerbst et al., 2010; Ammenwerth et al., 2012). "
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    ABSTRACT: Better knowledge of the habits and preferences of patients helps one understand why and how patients might need or want to access health services online and offline. Such knowledge provides a basis for designing systems for providing complementary health information. This article discusses how patients' conceptualizations of their health-information-related preferences, motivations, and needs are linked to the perceived role of medical records as an informational artifact. We identified seven subject positions: (P1) Hypothetically positive to e-health services generally, (P2) Positive to reading medical records due to implications, (P3) Positive to all Internet use including medical records online, (P4) Distrustful and wants to be in control of health treatment, (P5) Worried about health, (P6) Wants communication with health care professionals, and (P7) Do not understand their medical record. These subject positions can explain the worry and enthusiasm documented in earlier literature. The diversity of subject positions implies that health care information services should be planned with different subject positions in mind rather than a simple demographic group. Special attention needs to be given to finding flexible solutions that address the opportunities and worries of the identified subject positions.
    Journal of the Association for Information Science and Technology 05/2015; DOI:10.1002/asi.23343 · 2.23 Impact Factor
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