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Patient Activation and Motivational Interviewing

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Patient Activation and Motivational Interviewing. Presented by: Susan Butterworth, PhD, MS. Associate Professor. Oregon Health & Science UniversityPresident, Q-Consult – PowerPoint PPT presentation

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Title: Patient Activation and Motivational Interviewing


1
Patient Activation and Motivational Interviewing
  • Presented by
  • Susan Butterworth, PhD, MS
  • Associate Professor
  • Oregon Health Science UniversityPresident,
    Q-Consult

2
Objectives
  • Introduce construct of patient activation and
    Patient Activation Measure
  • Present theory of the relationship between
    patient activation and MI
  • Explore value of patient activation scores in
    MI-based intervention

3
Give a man a fish and you feed him for a day.
Teach a man to fish and you feed him for a
lifetime. - Chinese Proverb
Patient Activation Judy Hibbard, PhD
4
Why is activating the patient so important?
  • Healthcare resources are scarce it is
    increasingly important for people to take an
    active role in managing their care
  • Lifestyle management is the key to prevention and
    treatment of chronic conditions
  • Activation can be influenced in a brief
    intervention and, in turn, influences the person
    across all risk factors
  • Patient activation is correlated with multiple
    outcomes

5
Activation is related to many outcomes
6
Patient Activation Measure
  • PAM 13 Low Literacy

7
Activation is Developmental
8
HRA Research
10,000 survey participants No association
between having chronic condition and low PAM
scores.
Addiction
Diabetes 1 Asthma Diabetes 2 CAD Chronic
Pain COPD Heart Failure Mental Health
Implications Healthcare industry may want to
re-examine how they identify people for intensive
interventions
9
Patient Activation and MIHow can multiple
behaviors be changed even when all the behaviors
for each participant are not being treated?
Knowledge
Change Talk
Patient Activation
Commitment Strength
Health Coach
Skills
MI
10
Patient Activation and MIFocusing on patient
activation as overarching targeted behavior
Patient Activation
11
Study 1 MI-based Health Coaching as Chronic
Care Intervention
  • Quasi-experimental design over 8 month period
  • Employees at large medical university
  • Chronically ill group enrolled in health coaching
  • Staff extensively trained in MI little training
    in patient activation
  • Outcome measures
  • Perceived global health
  • Self-efficacy for managing chronic illness
  • Patient Activation
  • Stage of change for most important behavioral
    risk
  • Lifestyle management

12
MI-based Health Coaching Intervention
13
Outcome for Patient Activation
p 0.02 IPTW adjusted
14
Outcomes
  • As compared to control group, treatment group
    also had significant improvement in
  • Perceived global health
  • Self-efficacy for managing chronic illness
  • Stage of change for most important behavioral
    risk
  • Lifestyle management

15
Tailored Coaching Study
  • Disease management organization
  • Minimal training for all staff in MI
  • Extensive training in tailoring coaching based on
    patient activation level for staff in treatment
    arm
  • Intervention group coached on activation level.
  • Control group received usual care coaching
  • Outcome measures claims data, clinical
    indicators and activation levels
  • 6 month intervention period

16
Outcome for Patient Activation
17
Outcomes
  • Those who received coaching with the PAM
  • 33 decline in hospital admissions compared to
    the control group, which remained flat
  • 22 decline in emergency room visits compared
    with an increase of 20 in the control group.
  • Significant improvements in diastolic blood
    pressure and LDL cholesterol levels relative to
    control group
  • Significantly increased adherence to recommended
    immunization and drug regimens

18
What does a PAM score tell us?
19
Case 1
  • Maria Gonsalves has had diabetes for 20 years and
    has just been diagnosed with Congestive Heart
    Failure. Her patient activation score is low. She
    seems preoccupied when you try to talk to her and
    close to tears.
  • What is your approach with her?
  • What is your goal for the first couple of
    sessions?
  • In your small group, role play at least 2
    different approaches that you could use. Which
    approach can you use that will help
    address/improve patient activation?

20
Case 2
  • William Bickle has been going to your clinic for
    5 years. He has a reputation as being difficult.
    You are newly assigned to him as care manager.
    His labs have generally been good but you notice
    that they have recently been out of range in a
    number of areas. His patient activation score is
    high.
  • What is your approach with him?
  • What is your goal for the first couple of
    sessions?
  • In your small group, role play at least 2
    different approaches that you could use. What
    approach could you use that will support his
    patient activation?

21
Case 3
  • Rose Ann Yardley has been a patient of yours for
    a while and you have good rapport. She has low
    patient activation and you have noticed that she
    is not proactive about her health, depending on
    you and the doctor to tell her what to do. She
    also listens to patients in dialysis give advice
    and sometimes gets confused. You have approached
    her about moving from a catheter to a fistula but
    another patient has told her a horror story about
    how his didnt work out. In an initial brief
    discussion, she told you that she doesnt want to
    change her catheter and why. This is your second
    session with her.
  • What is your approach with her?
  • In your small group, role play at least 2
    different approaches that you could use. What
    approach could you use that will address/improve
    her patient activation?

22
In Summary
  • Patient activation may be an important underlying
    mechanism of MI
  • It may be helpful to provide training to
    healthcare providers/coaches in patient
    activation in addition to MI
  • Patient activation scores can be used to
  • Identify patients at risk
  • Provide additional risk factor information to
    healthcare staff
  • Guide health coaching approach
  • Measure outcomes of an MI-based intervention.

23
Resources
  • For more information on PAM, go to
    www.insigniahealth.com
  • For list of citations regarding patient
    activation, email me at butterwo_at_comcast.net
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