Patient Activation

In Sunderland health and social care services are working together to help people stay as well as possible and out of hospital, if they don’t need to be there.

We particularly aim to help those with the most need who might have more than one long-term, complex condition – either physical or emotional – and who use a high level of services provided by the NHS; local council and other support organisations, including local charities.

Evidence shows that people who have the knowledge, skills and confidence to manage their own health wellbeing experience better health outcomes. Yet the ability of people to successfully manage their long term conditions (LTCs) better can vary considerably from person to person. So it is important that we understand those people’s ability to do that.

Data highlighted in a Kings Fund report Supporting people to manage their health: An introduction to Patient Activation also shows that patients with the lowest activation levels had average costs that were 8% higher in the base year and 21% higher in the next year than patients with the highest activation levels.

The Patient Activation Measure (PAM) is a tool which enables this by capturing how engaged and confident someone is in taking care of their health.  This can be described as their activation level.

By finding out someone’s activation level, professionals can get an idea, not only of how much support someone might need to look after themselves better, but also how to tailor that support better to fit with that persons need depending on their level of activation.  One size health care does not fit all, for example, those with very low activation level may be easily overwhelmed by a conversation about their condition and how to manage it.

Patient Activation FAQs:

What is patient activation?
  • ‘Patient activation’ is a widely recognised concept. It describes the knowledge, skills and confidence a person has in managing their own health and health care.
  • The Patient Activation Measure (PAM) is a patient-reported measure that has been validated in the UK. It is a powerful and reliable measure of patient activation.
  • Patient activation scores have been robustly demonstrated to predict a number of health behaviours. They are closely linked to clinical outcomes, the costs of health care and patients’ ratings of their experience. Highly activated patients are more likely to adopt healthy behaviour, to have better clinical outcomes and lower rates of hospitalisation, and to report higher levels of satisfaction with services.
  • People who have low levels of activation are less likely to play an active role in staying healthy. They are less good at seeking help when they need it, at following a doctor’s advice and at managing their health when they are no longer being treated. Their lack of confidence and their experience of failing to manage their health often means that they prefer not to think about it.
  • Patients with low activation levels are more likely to attend accident and emergency departments, to be hospitalised or to be re-admitted to hospital after being discharged. This is likely to lead to higher health care costs.
  • The relationship between patient activation and health outcomes has been demonstrated across a range of different populations and health conditions.
  • Intervening to increase activation can improve a patient’s engagement and health outcomes and is an important factor in helping patients to manage their health. Improvements in patient activation scores have been seen for up 18 months following intervention.
  • Tailoring service delivery according to patient activation levels can maximise productivity and efficiency by ensuring that the level of support provided is appropriate to the needs of the individual.
  • Patient activation is a powerful mechanism for tackling health inequalities. Used in population segmentation and risk stratification, it provides new insights into risk that go beyond those obtained using traditional socio-demographic factors.
  • Patient activation provides a unique measure of engagement and empowerment that can be used to evaluate the effectiveness of interventions and to measure the performance of health care organisations in involving patients in their own care.

ATB Sunderland Patient Activation Levels Diagram

ATB Sunderland Patient Four Activation Levels Diagram

Can measuring patient activation drive real improvements?
  • Understanding activation levels help patients and clinicians to determine the realistic “next steps” for individuals to take in term of self-management
  • It allows for training and education resources to be tailored to the levels of activation of different individuals within the population
  • It can support more appropriate allocation of resources towards people at lower levels of activation and who are less confident about their ability to manage their own care.
  • It can enable equality and health inequalities to be tackled more effectively by targeting interventions at disadvantaged groups to increase their health literacy and patient activation.
  • Make the most effective use of a GPs time by tailoring support and reducing ineffective appointments.
How can measuring patient activation help clinicians?

Measuring patient activation gives healthcare professionals a starting point to meet the patients ‘where they are’, helping them to tailor the approach to individuals’ appropriately and assess a person’s ability to take on self-management health tasks.

Importantly, it can help to shape the agenda for a consultation, including exploring patient expectations and motivations as well as best options for supporting the patient to increase their levels of knowledge, skills and confidence, and so increase their self-care and reduce pressures on health and social care.

Understanding a person’s level of activation can help clinicians to identify interventions and options that are appropriate and realistic for individuals. It can also help identify where a carer’s help may be valuable, for example in supporting a person to understand and take their medicines. It can help clinicians to monitor a person’s progress, such as where a care plan has been agreed. Measuring a patient’s activation at different stages in the plan provides objective feedback to both clinician and patient on goals relating to self-management.

All of these support clinicians to develop a more person-centred approach in their interactions with patients.

How can PAM be used in practice?

The PAM can be used as a:

  • Tailoring tool – Measuring patient activation gives healthcare professionals a starting point to meet the people ‘where they are’, helping them to tailor their approaches to the individuals more appropriately to support them on their ‘journey of activation’. Using the PAM in this way as a tailoring tool encourages the provision of proactive system support for people with long-term conditions to develop the skills, knowledge and confidence to manage health and keep well at home. For example, one GP practice in Sheffield has redesigned their diabetes review process through offering longer appointments using the PAM to tailor discussion according the individual’s level of activation.
  • Tailoring tool and outcome measure – As a quantifiable measure, PAM can be used at scale and to assess whether the services/interventions are providing effective and tailored support to people’s needs. Aggregate/cohort PAM scores can be used to evaluate commissioned programmes to understand if they increased people’s activation, or if any changes are required to the types of services required in the local area according to people’s needs. It can be used to compare outcomes from different programmes.

ATB Sunderland Increasing Levels of Activation Diagram