Implementing the Patient Activation Measure (PAM) in clinical settings for patients with chronic conditions: a scoping reviewImplementing the Patient Activation Measure (PAM) in clinical settings for patients with chronic conditions: a scoping review

Abstract

ObjectiveThe Patient Activation Measure (PAM) assesses the knowledge, skills and confidence of patients to manage their health, and has been consistently used as an outcome measure of health interventions. Using the PAM to tailor interventions to a patient’s activation level is less understood. This literature review aimed to examine evidence for interventions using the PAM to tailor care for patients with chronic conditions, including enablers and barriers to implementation, and the impact on quality of care.Methods and analysisA scoping review methodology was used to identify literature reporting on PAM-tailored interventions. The Insignia Health website and Medline database were searched. Included papers were published in English from 2004 to 2017, from Organisation for Economic Cooperation and Development countries, included adult patients with chronic conditions, and a PAM-tailored intervention. Eligible full-text papers were assessed against the inclusion criteria. Data were extracted into tables and summarised to assess the key findings, recurring themes and differences across papers.ResultsTwenty-one papers describing the use of PAM-tailored interventions (n=21) were identified. Interventions included motivational interviewing, health coaching, self-management planning and risk profile assessment. The perceived value and function of the PAM held by organisations, clinicians and patients influenced implementation and use. Evidence for the impact of PAM-tailored interventions on quality of care was limited.ConclusionThe PAM is being used to tailor a range of interventions for patients with chronic conditions. Clinician perceptions and understanding about the PAM’s value and purpose influenced implementation. Further research is needed about how PAM-tailored interventions can be integrated into clinical practice, and guide the patient-clinician interaction, in ways that improve the quality of patient care.

The effect of the Take Charge intervention on mood, motivation, activation and risk factor management: Analysis of secondary data from the Taking Charge after Stroke (TaCAS) trial

“…There is uncertainty whether interventions aimed at increasing activation improve important health outcomes. 19,20…”

Patient activation and patient-reported outcomes of men from a community pharmacy lifestyle intervention after prostate cancer treatment

“…Previous research has shown that even a 1-point improvement in the latter is clinically relevant and that each point increase in PAM score correlates to a 2% decrease in hospitalization and 2% increase in medication adherence [29]. PAM has been widely adopted, especially in the UK and USA, and it has been used as an outcome measure to evaluate the effectiveness of healthcare interventions [33]. A substantial body of evidence exists to support the use of the PAM in clinical practice for the assessment and targeting of patients that require more support [34].…”

“…A recently published systematic review found that the level of PAM was associated with a variety of clinical indicators (e.g. BMI), health outcomes and behaviours [33]. It was also shown that PAM is a significant predictor of healthcare service utilisation and that less activated patients have higher healthcare costs.…”

Activating people to partner in health and self‐care: use of the Patient Activation Measure

“…Self‐care behaviour varies significantly depending on activation level. Higher PAM scores, regardless of illness type, are associated with improved patient self‐management behaviour (eg, medication adherence, healthy diet, engagement in regular exercise, and stress management) 3,6,7,20 . This is reflected in all types of preventive behaviour, meaning that a person’s activation level is a predictor of self‐care 6 .…”