What is patient activation?

Patient activation is defined as ‘an individual’s knowledge, skill, and confidence for managing their health and health care’ (Hibbard et al 2005). The more activated a patient or consumer is, the more empowered and engaged they are in their health care and well-being. Patient activation is a behavioural concept and a positive change in activation leads to positive change in a variety of self-care behaviours. This leads to improved health outcomes and reduces costs across the healthcare system.

Duggan et al., under the Australian Health Policy Collaboration undertook a Commissioned Report (No 2017-02) into the state of self-care in Australia. They discovered that most individuals, families and communities are willing to take some responsibility for their health, inclusive of disease management and chronic conditions, but need support to do so. Chronic disease and long-term health conditions are a struggle point for the Australian healthcare system and greater patient activation can reduce the impacts.

How does Australia’s healthcare system implement patient activation?

You’ll find an iPad in the waiting room of many Australian health services that seek to gather the Net Promoter Score™ (NPS) of patients. This data helps services understand how well they meet a patient’s expectations and identifies areas for improvement, yet its focus is on the service rather than the patient themselves.

Recognising the limitations of this measuring system, the use of Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcomes Measures (PROMs) are becoming a more permanent fixture across the Australian healthcare system. These two measures link closely to person-centred and value-based care by assessing experience and health outcomes from the patient’s perspective.

Understanding the benefits of greater patient engagement and involvement is undoubtedly a focus as Australia navigates the future of healthcare. Although the intention is there, operationally making change at a systematic level will take time, but there are already steps to achieve better patient activation.

A prime example of this shift in healthcare delivery is implementing Aboriginal Community Controlled Health Services (ACCHOs) across the primary health sector. Each ACCHO works with local Aboriginal and Torres Strait Islander peoples to support the Close the Gap Campaign. ACCHOs are working to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation.

ACCHOs embody the Aboriginal definition of health, which is not just about an individual’s physical wellbeing but also the social, emotional and cultural well-being of the community. In their primary care delivery, they take a whole-of-life perspective that incorporates a cyclical concept of life–death–life. ACCHOs provide an integrated approach to care that includes health education, health promotion, social and emotional well-being support and a range of other community development initiatives.

Aboriginal and Torres Strait Islander health workers are equipping their patients to better manage their health with knowledge, skills and confidence, ultimately supporting them to increase their activation levels.

How to measure patient activation

Over 600 peer-reviewed, published studies worldwide substantiate the Patient Activation Measures^® (PAM^®) as a validated interval scale tool that has the ability to measure patient activation.

Considering Australia has a population of over 25.7 million, measuring patient activation is a simple process using the Patient Activation Measure^® (PAM^®) survey. Although there are no nationally consistent tools being used in Australia to measure the behaviours of patients in response to their care, the PAM^® survey offers a comprehensive, easy-to-implement solution to assess a person’s activation level (or self-care ability). For instance, those that have a higher-level activation are more likely to follow a regular exercise schedule, take their medication, do their tests, and take more preventative measures. And no matter what preventative behaviours you look at – they will all show the same results. Therefore, a person’s activation level is a predictor for self-care.

The PAM^® is a 10 or 13 item survey that involves a quick assessment of a person’s underlying knowledge, skills, and confidence in managing their health and healthcare (self-care). Upon completion of the PAM^®, a consumer is usually subdivided into  one of four levels of activation :

• Level 1: Disengaged and overwhelmed (low activation)
• Level 2: Becoming aware but still struggling
• Level 3: Taking actions
• Level 4: Maintaining behaviours and pushing further (high activation)

As well as gaining an activation level, each individual receives a score between 0 and 100.  This score provides more detailed insights into their capabilities, beliefs and likely behaviours concerning their healthcare.

Due to the ease of use of the PAM^® survey and the comprehensive analysis tool, reliable and valid data can be gained quickly and regularly to understand large populations.

Key functions of PAM^®:

1. Improving segmentation and risk stratification: Traditional risk models rely upon past utilisation and have been shown to miss over half of the individuals in the lower two activation levels. Research consistently shows that lower activation is an indicator for disease progression, like diabetes or depression, as well as increased ED visits, hospital admissions, and ambulatory care sensitive (ACS) utilisation.
2. Tailoring support to PAM^® level: Increasing activation starts by measuring activation level. PAM^® can be used as a tool to help design and deliver touchpoints of care to support patient enablement and self-care. Once a care providers has the PAM^® score or activation level they have the ability to tailor service delivery to patient activation level ensuring that the level of support they provide is appropriate to the needs of the individual. The care provider can then gradually increase the person’s activation level – namely increasing their knowledge, skills and confidence to self-care and this will lead to improved patient experience, care management and health outcomes.
3. Measuring impact: Even a single point change in PAM^® score is meaningful.  By periodically re-administering the PAM®survey, the impact of patient support strategies and programs can be understood well in advance of traditional outcome measures.

CFEP Surveys’ Patient Activation Measure^® (PAM^®) Survey

CFEP Surveys is the exclusive Australian licensee of the PAM^® survey.

View our product page to learn more about CFEP Surveys’ patient activation measure offerings.

If health organisations, health policy, care providers and other stakeholders are genuinely interested in implementing person-centred models of care, which empower people to become partners in health and care, then an investment in PAM^® will achieve this with proven evidence to improve: self-care, health outcomes, health care costs, patient and care provider experience (that is, improve the quadruple aim in health).

CFEP Surveys recognises that implementing healthcare reform to better the wellbeing of Australians is no small task, but individual efforts contribute to more significant results. If patients could be better equipped and confident in better understanding, engaging and managing their health, we’d have a significantly healthier and happier nation. CFEP Surveys patient activation measure^® can support this goal, and we look forward to working with health services to increase patient activation.

To learn more about CFEP Surveys’ PAM offerings, contact the team today.