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

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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

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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
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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

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Activation is related to many outcomes
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Patient Activation Measure

• PAM 13 Low Literacy

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Activation is Developmental
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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
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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
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Patient Activation and MIFocusing on patient
activation as overarching targeted behavior
Patient Activation
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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

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MI-based Health Coaching Intervention
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Outcome for Patient Activation
p 0.02 IPTW adjusted
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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

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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

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Outcome for Patient Activation
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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

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What does a PAM score tell us?
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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?

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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?

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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?

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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.

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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