What is patient activation?
Patient activation is a term we are hearing a lot about recently. And, whilst it is not a new concept, it is certainly one that is beginning to take a new form, moving from a theoretical idea referenced only in journals to one being practically embraced by practitioners globally.
When we talk about ‘patient activation’ we’re talking about the process through which we engage or motivate a patient to play an active role in their own health and care. This is instead of the more traditional and passive role of being ‘told what to do’ by a health professional.
For patient activation to occur, patients must first have the right knowledge, skills and confidence to look after their health and make informed decisions about their care. This means they must know where and when to get help in order to prevent complications.
Evidence shows that ‘activated patients’ are more likely to play an active role in staying healthy. They are better at seeking help when they need it, and they are better at following the advice of clinicians, tending to stick to their management plans longer than non-activated patients after receiving treatment.
Because of this, activated patients are less likely to have avoidable hospitalisations, and they have less unnecessary attendances at emergency departments.
How can we measure patient activation?
There is a Patient Activation Measurement (PAM) tool, which can be licensed for use from insigniahealth.com. This is a validated tool that determines an activation score based on the answers a patient provides about their current level of activation.
What are the 4 levels of patient activation?
Level 1: Patients tend to be passive and feel overwhelmed by managing their own health. They may not understand their role in the care process.
Level 2: Patients may lack the knowledge and confidence to manage their health.
Level 3: Patients appear to be taking action but may still lack the confidence and skill to support their behaviours.
Level 4: Patients have adopted many of the behaviours needed to support their health but may not be able to maintain them in the face of life stressors.
How can practices support patients at each level?
Level 1: Focus on building self-awareness and confidence through small steps. This often begins with empowering patients with education by supplying them with quality health information in patient-friendly language. This can also involve using a health coaching approach of asking questions and getting the patient to identify what they feel is a problem or an issue on their own. This patient-centred approach is particularly useful for getting patients to self-identify lifestyle changes.
Level 2: Help patients continue taking small steps, such as adding a new fruit or vegetable to their diet each week, or reducing their portion sizes over time. We can also help them build up their basic health knowledge by giving them access to new resources. At this stage it is also important to encourage patients to ask questions so they remain actively involved in their health journey.
Level 3: Slowly encourage patients to adopt new behaviours by introducing them to fresh knowledge and skills about their health conditions. At this point it is also important to highlight the achievements the patient has made up until this stage so they remain motivated.
Level 4: Focus on preventing a relapse by preparing the patient to handle new and challenging situations. This involves problem solving from both the patient and the practitioner as together you plan for how to cope with difficult situations as they arise. These strategies can be integrated into the workflow of patient encounters, such as when we see them for services like health assessments, chronic disease management plans, Immunisations and even opportunistically as part of usual care. It’s important to set short, medium and longer term goals and to regularly review these with patients to make sure they stay engaged and activated.
Diabetes Example Case Study:
As a fictional case study, let’s introduce Betty, a middle-aged female who was diagnosed with diabetes a few months ago. She was referred to an endocrinologist and a podiatrist when she first received the diagnosis and has now shown up on your records as a patient needing support managing her condition.
Level 1: She was invited to meet with the practice nurse to put a management plan in place. At the time, the nurse asked if Betty had any questions about her diabetes, but she simply replied that there’s too much to take in right now and she’s just hoping things will get sorted out when she finally gets to have her appointment with the specialist.
Intervention: The nurse reassures Betty that she can contact the practice at any time if she has questions and books her for a follow up appointment after her specialist visit.
Level 2: Betty returns to the practice after meeting with the specialist and tells the nurse she is just going to try to take her medication until things get back to normal.
Intervention: The nurse talks to Betty about the benefits of seeing a diabetes educator, who could help her get a better understanding of her condition and what to focus on as she learns to adjust to the medication regime. Another follow up appointment is booked to catch up after the session with the diabetes educator.
Level 3: Betty seems much more optimistic about her health after seeing the diabetes educator. She talks about how she now realises how important it is to make sure she looks after herself to prevent complications with her eyes and feet.
Intervention: The nurse talks to Betty about how great it is that she is keen to play an active role in staying healthy and encourages her to identify a personal health goal that Betty may want to work on. Betty suggests she would like to lose some weight because the specialist also mentioned that would help with her diabetes. The nurse asks her a series of questions to see what Betty feels she could start doing in her daily life that would help her reach that goal. Betty decides she’s been meaning to add more vegetables into her diet and will try to replace some of her takeout meals during the week with home-cooked meals instead. A follow up appointment is set for 2 weeks time to check on the progress of Betty’s new healthy eating and cooking goal.
Level 4: Betty returns and is quite excited about the changes she’s made with her home-cooked meals. She’s even lost a bit of weight already and says her energy levels are much better. She is somewhat worried that she has family coming to stay with her over the next few weeks as she says they are ‘big eaters and love to eat out’. She’s concerned that she’ll fall off the wagon and return to unhealthy habits while they are here.
Intervention: The nurse congratulates Betty on her fantastic progress so far and then helps Betty come up with some strategies she feels might work to help her stay focused while her relatives are in town. Betty decides that she will aim to stick to her goal of eating more vegetables and will make sure to pick healthier choices if she is out with her relatives.