Patient Activation

RHP 12 Learning Collaborative Package One

Debra Flores, Ph.D.

Participants will:1) Participants will name and describe the different types of self-management support systems2) Participants will compare and contrast traditional patient education and self-management education3) Participants will compare and contrast traditional care and collaborative care in chronic illness4) Participants will have a general understanding of motivational interviewing5) Participants will describe the components of Patient Activation6) Participants will review patient activation tools

Objectives

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

Interviewing) Peer support (Navigation) Role Negotiation (Patient Activation)

Different types of self-management support

In the Clinical Setting

In the Acute Care Setting

Post Hospitalization

◦ Select an aim of what the focus of the education will involve, i.e. Diabetes, Hypertension, CHF.

◦ Select the team member that will be designated to deliver the education

◦ Create a script with materials if available to deliver the education

◦ Deliver the education ◦ Keep a record of the

patients educated

Patient Education & Skill Development

Traditional Patient Education vs. Self-Management Education

Issue Traditional Patient Education Self-Management Education

What is taught? Information and technical skills about the disease

Skills on how to act on problems

How are problems formulated? Problems reflect inadequate control of the disease

The patient identifies problems he/she experiences that may or may not be related to the disease

Relation of education to the disease

Education is disease-specific and teaches information and technical skills related to the disease

Education provides problem-solving skills that are relevant to the consequences of chronic conditions in general

What is the theory underlying the education?

Disease-specific knowledge creates behavior change, which in turn produces better clinical outcomes

Greater patient confidence in his/her capacity to make life-improving changes (self-efficacy) yields better clinical outcomes

What is the goal? Compliance with the behavior changes taught to the patient to improve clinical outcomes

Increased self-efficacy to improve clinical outcomes

Who is the educator? A health professional A health professional, peer leader, or other patients, often in a group setting

Issue Traditional Care Collaborative CareWhat is the relationship between patient and health professionals?

Professionals are the experts who tell patients what to do. Patients are passive

Shared expertise with active patients. Professionals are experts about the disease and patients are the experts about their lives

Who is the principal caregiver and problem solver? Who is responsible for outcomes?

The professional The patient and professional are the principal caregivers; they share responsibility for solving problems and for outcomes.

What is the goal? Compliance with instructions. Noncompliance is a personal deficit of the patient

The patient sets goals and the professional helps the patient make informed choices. Lack of goal achievement is a problem to be solved by modifying strategies.

How is the behavior changed? External motivation Internal motivation. Patients gain understanding and confidence to accomplish new behaviors

How are problems identified By professional, eg, changing unhealthy behaviors

By the patient, eg, Pain or inability to function; and by the professional

How are problems solved? Professionals solve problems for patients

Professionals teach problem-solving skills and help patients in solving problems.

Problem Solving and Goal Setting

http://vimeo.com/56949751

Behavioral Techniques

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”

Patient Activation

Level One Building knowledge and confidence

Individuals do not feel confident enough to play an active role in their own health. They are predisposed to be passive recipients of care

Level Two Building knowledge and confidence

Individuals lack confidence and 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

Role Negotiation(Patient Activation)

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

Patient Activation Measures Predictions

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

Outcomes for Activated Patients

Study Setting Intervention Results

“Self-Management for Patients with HF” (2013) Shively & Colleagues

Hospital (N=82, 41 participants in intervention group & 41 in control group)

Blood Pressure cuff, weight scale, & pedometer, self-management DVD and Education booklet

Patient Activation could be improved through a targeted intervention and the effect was more pronounced for the medium-level activation

“Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers” (2004) Hibbard et al

Clinical (N=479 controlled and randomized trail)

Self-Management tailoring care plans to activation levels

Positive impact of tailored interventions with improved clinical indicators such as blood pressure and lipids

“Self-management counseling in patients with HF: The Heart Failure adherence and retention randomized behavioral trail” (2010) Powell & Colleagues

Hospital (N=902) Efficacy of self-management HF counseling and education

No remarkable results

“How do people with different levels of activation self-manage their chronic conditions?” (2009) Dixon, Hibbard & Tusler

Outpatient (N=27) Management of chronic conditions with different activation levels

Self-Management support needs to be tailored for the different levels of activation

Multi-Site Study

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 in case"

Gather "just enough" data to learn and complete another cycle

Duration Can take long periods of time to obtain results

"Small tests of significant changes" accelerates the rate of improvement

Measurement for Learning & Process Improvement

Tracking Clinical Outcomes

Self-Efficacy for Managing Chronic Disease.pdf

English Self-Efficacy for Diabetes.pdf

MOS_adherence_survey.pdf

Other Activation Tools

PatientActivation-1.pdf RAND 36-MOS-Measure of Patient Adherenc

e.docx Spanish Chronic Disease Self-Efficacy.pdf Spanish Diabetes Self-Efficacy.pdf

Other Resources

Question/Discussion

Thank you!