OA21 Use of the patient activation measure in rheumatology outpatients

Abstract

Abstract Background/Aims Our rheumatology department is considering introducing patient-initiated follow-up (PIFU) for patients with stable inflammatory conditions. This will require patients to be motivated and appropriately seek help when required. The 13-item Patient Activation Measure (PAM-13) is a tool that measures patients' knowledge, skills and confidence in managing their health and is categorised into levels of increasing activation - level 1 (disengaged and overwhelmed), level 2 (becoming aware, still struggling), level 3 (taking action), and level 4 (maintaining behaviours, pushing forwards). Our aim was to describe the distribution of patient activation scores in a cross section of patients attending rheumatology return appointments. Methods Clinic patients were asked to complete a form which comprised demographic and disease background information, the PAM-13 and the Arthritis Self Efficacy Score (ASES). All data were anonymised. Demographic details included age, sex, postcode (for Scottish Index of Multiple Deprivation (SIMD) calculation), educational attainment, employment status, living situation, and requirement for assistance with activities of daily living (ADLs). Disease related details were main rheumatological diagnosis, years since diagnosis, patient opinion of disease control, and global health visual analogue score (VAS). Patient Health Questionnaire 2 (PHQ-2) and Generalised Anxiety Disorder 2 (GAD-2) were used to screen for mental ill-health. Results A total of 209 responses were collected. Patients fell into the following activation levels: level 1 - 25.4%, level 2 - 32.5%, level 3 - 24.4%, and level 4 - 17.7%. Patients in level 1 were compared to patients in levels 2 - 4 to establish trends. Those in level 1 less frequently felt that their rheumatic disease was well controlled (52.8% vs 72.4%). Level 1 patients were more likely to live in the most deprived areas (41.5% in SIMD quintile 1 vs 26.9%); had lower rates of full or part time employment (22.7% vs 53.2%) and higher rates of unemployment due to disability (22.6% vs 8.3%); had lower rates of educational attainment (11.3% with university education vs 21.8%); more frequently required assistance with their ADLs (62.3% vs 26.3%) and reported higher levels of depression (58.5% vs 25.6%) and anxiety (41.5% vs 24.4%). Level 1 patients reported lower global VAS (median 50 vs 70) and lower ASES (median 3.8 vs 6). Conclusion 57.9% of our patients fell into low activation levels 1 and 2. Those in the lowest activation group had the highest proportion of patients from areas with high rates of deprivation, lowest rates of employment and higher educational attainment, and highest rates of requiring assistance with ADLs, depression and anxiety. The converse was true for those in the highest level of activation group. These patients may not be appropriate for new PIFU or may require additional, tailored support for it to be safely implemented. Disclosure C.R. Wood: None. J.E. Dale: None.