Patient Activation

RHP 12 Learning Collaborative

Package One
Debra Flores, Ph.D.
Objectives

Participants will:
1) Participants will name and describe the different types
of self-management support systems
2) Participants will compare and contrast traditional
patient education and self-management education
3) Participants will compare and contrast traditional care
and collaborative care in chronic illness
4) Participants will have a general understanding of
motivational interviewing
5) Participants will describe the components of Patient
Activation
6) Participants will review patient activation tools
Different types of self-
management support

 Patient Education
 Self-Management Education
 Problem Solving and Goal Setting
 Behavioral Techniques (Motivational

Interviewing)
 Peer support (Navigation)
 Role Negotiation (Patient Activation)
Patient Education &
Skill Development

 In the Clinical ◦ Select an aim of what the

focus of the education will
Setting involve, i.e. Diabetes,
 In the Acute Care Hypertension, CHF.
◦ Select the team member
Setting that will be designated to
 Post Hospitalization deliver the education
◦ Create a script with
materials if available to
deliver the education
◦ Deliver the education
◦ Keep a record of the
patients educated
Traditional Patient
Education vs. Self-
Management Education
Issue Traditional Patient Education
What is taught? Information and technical skills
about the disease
How are problems formulated? Problems reflect inadequate control
of the disease
Relation of education to the disease Education is disease-specific and
teaches information and technical
skills related to the disease
What is the theory underlying the Disease-specific knowledge creates
education? behavior change, which in turn
produces better clinical outcomes
What is the goal? Compliance with the behavior
changes taught to the patient to
improve clinical outcomes
Who is the educator? A health professional
Self-Management Education
Skills on how to act on problems
The patient identifies problems
he/she experiences that may or may
not be related to the disease
Education provides problem-solving
skills that are relevant to the
consequences of chronic conditions
in general
Greater patient confidence in
his/her capacity to make life-
improving changes (self-efficacy)
yields better clinical outcomes
Increased self-efficacy to improve
clinical outcomes
A health professional, peer leader,
or other patients, often in a group
setting
Problem Solving and
Goal Setting
Issue
What is the relationship between
patient and health professionals?
Who is the principal caregiver and
problem solver? Who is responsible
for outcomes?
What is the goal?
How is the behavior changed?
How are problems identified
How are problems solved?
Traditional Care
Professionals are the experts who
tell patients what to do. Patients
are passive
The professional
Compliance with instructions.
Noncompliance is a personal deficit professional helps the patient
of the patient
External motivation
By professional, eg, changing
unhealthy behaviors
Professionals solve problems for
patients
Collaborative Care
Shared expertise with active
patients. Professionals are experts
about the disease and patients are
the experts about their lives
The patient and professional are
the principal caregivers; they share
responsibility for solving problems
and for outcomes.
The patient sets goals and the
make informed choices. Lack of
goal achievement is a problem to
be solved by modifying strategies.
Internal motivation. Patients gain
understanding and confidence to
accomplish new behaviors
By the patient, eg, Pain or inability
to function; and by the
professional
Professionals teach problem-
solving skills and help patients in
Behavioral Techniques

 http://vimeo.com/56949751
Patient Activation

 Patient activation is a critical component of

chronic disease management and transitional
care
 Activation- “having the information,
motivation and behavioral skills necessary to
self-manage, chronic illness, collaborate with
health care providers, and access appropriate
care”
Role Negotiation(Patient
Activation)

Level One Building knowledge and Individuals do not feel confident

confidence enough to play an active role in
their own health. They are
predisposed to be passive
recipients of care
Level Two Building knowledge and Individuals lack confidence and
confidence understanding of their health or
recommended health regimen.
Level Three Taking action Individuals have the key facts and
are beginning to take action but
may lack confidence and the skill
to support their behaviors
Level Four Maintaining Behaviors Individuals have adopted new
behaviors but may not be able to
maintain them in the face of
stress or health crisis
Patient Activation
Measures
Predictions
 Healthy behaviors such as
diet and exercise
 Disease self- management
such as adherence to drug
regimens, monitoring and
management of symptoms
 Medical encounter
behaviors
 Seeking health information
Outcomes for
Activated Patients

 Improved adherence to
medications
 Increased likelihood to eat

healthier and engage in

physical activity
 Increased presence in

workforce and increase job

satisfaction
 Decreased likelihood of ED

usage and readmissions post

discharge
 Increase engagement with

clinicians
Multi-Site Study
Study
“Self-Management for
Patients with HF” (2013)
Shively & Colleagues
“Development of the
Patient Activation Measure
(PAM): conceptualizing and
measuring activation in
patients and consumers”
(2004) Hibbard et al
“Self-management
counseling in patients with
HF: The Heart Failure
adherence and retention
randomized behavioral
trail” (2010) Powell &
Colleagues
“How do people with
different levels of
activation self-manage
Setting
Hospital (N=82, 41
participants in intervention
group & 41 in control
group)
Clinical (N=479 controlled
and randomized trail)
Hospital (N=902)
Outpatient (N=27)
Intervention
Blood Pressure cuff, weight
scale, & pedometer, self-
management DVD and
Education booklet
Self-Management tailoring
care plans to activation
levels
Efficacy of self-
management HF
counseling and education
Management of chronic
conditions with different
activation levels
Results
Patient Activation could be
improved through a
targeted intervention and
the effect was more
pronounced for the
medium-level activation
Positive impact of tailored
interventions with
improved clinical
indicators such as blood
pressure and lipids
No remarkable results
Self-Management support
needs to be tailored for the
different levels of
Measurement for
Learning & Process
Improvement
Measurement for Research Measurement for Learning and Process
Improvement

Purpose To discover new knowledge To bring new knowledge into daily

practice

Tests One large "blind" test Many sequential, observable tests

Biases Control for as many biases as possible Stabilize the biases from test to test

Data Gather as much data as possible, "just Gather "just enough" data to learn and
in case" complete another cycle

Duration Can take long periods of time to obtain "Small tests of significant changes"
results accelerates the rate of improvement
Tracking Clinical
Outcomes
Other Activation
Tools

 Self-Efficacy
for Managing Chr
onic Disease.pdf

 English Self-Efficacy for Diabet

es.pdf
 MOS_adherence_survey.pdf
Other Resources
 PatientActivation-1.pdf
 RAND 36-MOS-Measure of Patient Adherence
.docx
 Spanish Chronic Disease Self-Efficacy.pdf
 Spanish Diabetes Self-Efficacy.pdf
Question/Discussion
Thank you!