Abstract
BackgroundThere is increasing awareness of the importance of patient activation (knowledge, skills, and confidence for managing one’s health and health care) among clinicians and policy makers, with emerging evidence showing higher levels of patient activation are associated with better health outcomes and experiences of health care. This study aimed to examine the association between patient activation and a wide range of specific types of healthcare service utilisation in England, including GP and non-GP primary care, elective and emergency hospital admissions, outpatient visits, and attendances at the Accident and Emergency department.MethodsData were derived from linked electronic patient records collected by primary and secondary healthcare providers in North West London between January 2016 and November 2019. Our analyses focused on adults (18+) with a valid Patient Activation Measure (PAM). After excluding patients with missing data, we had an analytical sample of 15,877 patients. Data were analysed using negative binomial regression and logistic regression models depending on the outcome variable.ResultsPatients had a mean activation score of 55.1 and a standard deviation (SD) of 17.7 (range: 0–100). They had an average of 5.4 GP visits (SD = 8.0), 26.8 non-GP visits (SD = 23.4) and 6.0 outpatient attendances (SD = 7.9) within a one-year follow-up. About 24.7% patients had at least one elective admission, 24.2% had one or more emergency admissions, and 42.3% had one or more A&E attendance within the follow-up. After accounting for a number of demographic and health factors, we found a linear (or proximately linear) association between patient activation and the number of GP visits, emergency admissions and A&E attendance, but a non-linear relationship between patient activation and the number of non-GP visits, the number of outpatient attendance and elective inpatient admission.ConclusionsThis study has provided strong empirical evidence from England linking patient activation with healthcare service utilisation. It suggests the value of supporting patient activation as a potential pathway to ease the burden of healthcare system.
Highlights
Patient activation describes an individual’s knowledge, skills, and confidence for managing his/her health and health care [1]
We focused on multiple different types of healthcare service utilisation (GP and nonGP primary care, elective and emergency hospital admissions, outpatient visits, and attendances to the Accident and Emergency (A&E) department) and used patient activation as a continuous measure which allowed us to explore the possibility of non-linearity across the whole spectrum of patient activation and potentially within each level
Descriptive statistics Patients included in our analysis had a mean Patient Activation Measure (PAM) score of 55.1 and a standard deviation (SD) of 17.7
Summary
Patient activation describes an individual’s knowledge, skills, and confidence for managing his/her health and health care [1]. Patients who display low levels of activation are typically disengaged and overwhelmed, low in health-related knowledge, with poor levels of goalorientation and poor adherence to any preventative health regimes or treatments, seeing their health as the responsibility of their doctor. Patients who display high levels of activation act as their own health advocates, maintaining a healthy lifestyle with strong self-management skills, good knowledge of their own health, and a desire to help prevent future ill health [2]. Emerging evidence has shown that patient activation is clearly linked to a range of health-related outcomes. There is increasing awareness of the importance of patient activation (knowledge, skills, and confidence for managing one’s health and health care) among clinicians and policy makers, with emerging evidence showing higher levels of patient activation are associated with better health outcomes and experiences of health care.
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