Measuring knowledge, skills and confidence to self manage. Patient Activation Dr Alf Collins Clinical Associate in Person Centred Care The Health Foundation

Self management is usual care Hours with NHS / social care professional = 5-10 in a year Self management = in a year

So The system should work in partnership with people with LTCs in order to support them to develop the knowledge, skills and confidence to self manage

Supporting the partnership to work

What makes a good partnership?

Partnership in healthcare

10% of population 30% of population 40% of the population has low or no confidence to self manage

People at low levels of activation tend to: Feel overwhelmed with the task of managing their health Have low confidence in their ability to have a positive impact on their health Not understand their role in the care process Have limited problem solving skills Have had a great deal of experience with failure in trying to manage, and have become passive with regard to their health Say they would rather not think about their health

As compared to people at low levels of activation, people at higher levels tend to: ‘Be engaged’ – Come prepared – Ask questions – Make decisions – Have less unmet needs (nb inequalities) Have improved clinical outcomes (including mental health) Enjoy an improved quality of life Use less healthcare resource Feel satisfied at work Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Jessica Greene and Judith H. Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011

Uses of patient activation measure Segmentation Target resources Use resources more effectively Tailored coaching Start where people are Personalise support Programme assessment Quality assure interventions Improve quality of interventions Predictive modelling More sophisticated understanding of drivers of risk

People with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’

Activation as a primary mediator of other indicators. Activation Clinical outcomes, including mental health Improved QOL, wellbeing Higher rate of retention at work Feeling in controlMore independent Lower utilisation of health and social care resource

Tailored interventions- including health coaching- can support people on their journey of activation Thus tailored interventions improve all other ‘downstream’ indicators

The national learning set: using the concept and the PAM at scale

5 CCGs plus renal registry 150,000 patients over 2 years Learning plus rigorous evaluation – Pragmatics – Face validity – ‘Coaching for activation’ – Collaborative care and support planning – Understanding population health and reducing inequalities

Questions and challenges Concept or measure or both? PAM as an outcome? Personal outcomes Social model of health