Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom

Abstract

BackgroundPatient Activation is defined as the knowledge, skill, and confidence a patient has in managing their health. Higher levels of patient activation are associated with better self-management, better health outcomes, and lower healthcare costs. Understanding the drivers of patient activation can allow better tailoring of patient support and interventions. There are few data on patient activation in UK patients with long-term conditions.MethodsA prospective cohort design was used. Questionnaires were mailed to 12,989 patients over the age of 65 years with at least one long-term condition in Salford, UK. They completed the Patient Activation Measure and self-report measures of: depression, health literacy, social support, health-related quality of life, and impact of multimorbidity. We report descriptive data on baseline activation and change over time, and use multivariate regression to model associations with patient activation at baseline and predictors of change in Activation over 6 months.ResultsThe cohort included 4377 (33.6 %) older people, of whom 4225 were mailed a further questionnaire at 6 months; 3390 returned it complete (80.2 %). At baseline, 15 % self-reported PAM level 1, 16 % level 2, 45 % level 3, and 25 % level 4. Across all patients, depression had the strongest association with patient activation. Other important factors were: older age, being retired, poor health literacy, health-related quality of life, and social support. Total number of self-reported comorbidities and the perceived impact of comorbidities were also important for patients with more than one long-term condition.Patient activation scores were reasonably enduring over time (r = 0.43 between baseline and at six months), although nearly half changed ‘levels’ of activation over that time. Few variables predicted change in activation over 6 months.ConclusionsThis is the first large scale assessment of patient activation in the UK. Our data may be useful in identifying patients who need support with patient activation, and allow interventions (such as health coaching) to be tailored to better support older patients with long-term conditions who have symptoms of depression, poor social support and impaired health literacy. Further analyses of longitudinal studies will be necessary to better understand the causal relationships between patient activation and variables such as depression.

Outcomes of a 12-month patient-centred medical home model in improving patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia: A before-and-after study.

“…In the multivariable regression analyses, increase in age, PHI, and baseline PAM scores were signi cant predictors of PAM scores at the 12-month follow-up. Increase in years of age as a signi cant determinant of reduced activation is consistent with ndings of studies by Blakemore et al and Overbeek et al [38,39]. Preliminary qualitative feedback of the WellNet program showed that some elderly patients reported di culty in engaging with the online GoShare tool and MediTracker mobile application, thereby needing more assistance and coaching to access the electronic educational programs.…”

Outcomes of a 12-month patient-centred medical home model on patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia.

“…Overbeek et al [39,40]. It is reported that older adults have limited self-management skills as a result of having greater number of chronic conditions which are often associated with poor quality of life, reduced functional status and increased disabilities [39,41]. Consistent with the above study findings, WellNet group observed a higher mean number of co-existing chronic conditions among patients who were over the median age of 70 years compared to those who were less than or equal to 70 years.…”

“…Overbeek et al [39,40]. It is reported that older adults have limited self-management skills as a result of having greater number of chronic conditions which are often associated with poor quality of life, reduced functional status and increased disabilities [39,41].…”

Factors Associated with Level of Patient Activation and Its Role to Glycemic Control and among Adults with Type II Diabetes Attending Diabetic Clinic at Hospitals in Addis Ababa

“…Persistent actuation was low in those sort 2 diabetes patients with comorbidities. Essentially, in past examinations number of comorbidities and number of confusions were adversely connected with patient enactment level [32]. This could be because of patients with comorbid infection having less capacity to adapt to numerous conditions bringing about lower dimensions of initiation [33].…”