Measuring patient activation: The utility of the Patient Activation Measure within a UK context—Results from four exemplar studies and potential future applications

https://doi.org/10.1016/j.pec.2016.05.006Get rights and content

Highlights

  • The patient activation measure is a useful tool to measure readiness to engage.

  • PAM scores can help tailor support for those with long term conditions.

  • The PAM tool should not be used without clinical and sociodemographic information.

  • Further work is needed to monitor PAM through the patient journey.

Abstract

Objective

Patient activation can be measured using the Patient Activation Measure (PAM) developed by Hibbard et al., however, little is known about the uses of the PAM in research and in practice. This study aims to explore its differing utility in four UK exemplar sites.

Methods

Data from four exemplars in a range of health settings with people living with long-term conditions (i.e. stroke or COPD) were evaluated. PAM scores were described and explored in relation to clinical and sociodemographic variables and outcome measures.

Results

PAM scores illustrated that most with COPD or stroke reported PAM levels of 3 or 4, indicating that they are engaging, but may need help to sustain their scores. The exemplars illustrate the utility of, and potential issues involved in, using PAM as a process/outcome measure to predict activation and the effectiveness of interventions, and as a tool to inform tailoring of targeted interventions.

Conclusions

The PAM tool has been shown to be useful as an outcome measure, a screening tool to tailor education, or a quality indicator for delivery of care.

Practice implications

However good demographic and patient history are needed to substantiate PAM scores. Further work is needed to monitor PAM prospectively.

Section snippets

Background

It is widely acknowledged that healthcare systems in the UK and worldwide are facing profound challenges [1]. In the UK, the English National Health Service (NHS) five year forward view [2] states that due to an increasingly ageing population [3], the increasing prevalence of multiple long-term conditions [4], [5] and the limits to the available financial resources new models of care are needed to face the demands of the current population. Globally, there have been moves towards a culture of

Methods

Four exemplar data sets which involved the use of the PAM (permission received from Insignia Health (http://www.insigniahealth.com/solutions/patient-activation-measure) were identified and used. The exemplar datasets utilised a variety of approaches, were undertaken in a range of settings and included people living with long-term conditions (i.e. stroke or COPD) (Table 2). The four exemplars used for this report were identified locally from clinical and academic colleagues, all of whom were

Data analysis

Descriptive statistics were used in estimating means or medians together with their respective standard deviations or inter-quartile ranges. These were reported using the appropriate summary estimates for all demographic and clinical variables as well as PAM scores for each set of study data. All data were entered into and analysis carried out using SPSS (V.19.0). ANOVA with post hoc Tukey HSD comparisons (Exemplar 3), repeated measures ANOVA with a Greenhouse-Geisser correction (Exemplar 2),

Results

Table 2 summarises the characteristics and data from the four exemplars including two prospective studies and two retrospective secondary analyses of data previously collected from a Co-Creating Health site, and routine data from community care. The PAM tool was used differently in each exemplar (Table 2), corresponding with the reported applications in the literature [29] Table 2 shows the findings from each individual exemplar.

Discussion

The potential use of the Patient Activation Measure as a tool for measuring the effectiveness of, or to aid in the tailoring of, interventions and care delivery is fast becoming of interest across the UK. Existing data on its use, however, largely stems from the USA and therefore we know little about the feasibility and challenge of using the PAM within a UK context [12]. This prompted us to summarise data from four studies, conducted by the authors, using a case study approach to present data

Practice implications

The PAM tool is a potential tool which can be used both in research and service evaluation. However the tool should not be used in isolation, and good demographic and patient history details need to be recorded regularly and repeatedly to understand the basis for the PAM scores and the changes that might be evident over time.

Acknowledgements

The Carnegie Trust for the Universities of Scotland provided research funding for the prospective study (Exemplar 1). The Burdett Trust for Nursing provided funding for the stroke exemplar (Exemplar 4). Exemplars 2 and 3 were unfunded.

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