Patient Activation in Australians with Chronic Illness Project
The Patient Activation in Australians with Chronic Illness Project aimed to get a better understanding of the level of activation of health care consumers with chronic illnesses to ascertain how receptive they might be to models of service delivery that require them to be more involved in their own care. Often lack of engagement - or activation - is cited as a barrier to increasing self-management and shared decision-making and hence better experiences of care and health outcomes.
The Consumers Health Forum (CHF) utilised the Patient Activation Measure (PAM®) tool across a national sample of 1703 respondents to determine levels of patient engagement in Australia for adults with two or more chronic illnesses to inform better policy and strategies to support patient self-management. CHF had access to the PAM® tool under licence for research purposes. The PAM tool describes four levels of activation with Level 4 being consumer behaviours which show they are engaged with their own health care and Level 1 being consumers who are disengaged and feel overwhelmed by their condition.
Over one-quarter of respondents were classified as Level 4 (having adopted behaviours to support their health) with a further 41% of respondents classified as Level 3 (acting but lacking skill and confidence). This research project found that Australians with chronic illnesses with high levels of patient activation as measured by their PAM® level had better self-reported outcomes and experiences in the healthcare system. However, the overall proportion of Australian’s with chronic illnesses who reported having these high levels of activation, 68% in total, was lower than the level of high activation measured in the general Australian population, 85% in total, in a previous study. This suggests that Australians with chronic illnesses are less activated than their healthy counterparts which may be a contributing factor to their generally worse health outcomes.
The findings suggest that should health policy and practice systemically incorporate measures designed to improve levels patient activation, the overall health outcomes and experiences of Australians with chronic illnesses could be improved. Investing in measures to assist general practices and patients leverage patient activation to navigate the range of services they need to exercise choice and control in their healthcare as part of a comprehensive national primary health care reform strategy would deliver high value care for those with chronic illnesses. Measures should include shared decision-making practices, tools and resources to support shared-decision-making, evidence-based self-management services, workforce development in the form of practice-based health coaches and service coordinators and a social prescribing scheme.