Integrating Patient Activation Into Dialysis Care

et al. 2022

Kidney and Dialysis

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The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one’s own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual’s level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.

Section: Increasing Patient Activation and Self-management In Ckdmentioning

confidence: 99%

Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease?

Lightfoot

Nair

et al. 2022

Kidney and Dialysis

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“…The expected improvements in healthy behaviors and ownership of one's health care is the essence of person-centered care, and will support the transition to value-based care and the achievement of the quadruple aim: better patient outcomes; improved clinical experience; improved patient experience; and lower costs. 27 This study has several limitations and strengths. Data were obtained from 35 centers from three different states to improve generalizability.…”

Section: Discussionmentioning

confidence: 95%

“…Activation can address the learned helplessness phenomenon that occurs when people commence center HD 27 . Early recognition of learned helplessness through low activation offers several opportunities to improve care delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Early recognition of learned helplessness through low activation offers several opportunities to improve care delivery. Firstly, given that patients with low activation are less likely to engage with the health care system in response to signals of impending events, this group may benefit from more intensified surveillance and related interventions 27 . Secondly, our approach to education is best tailored to the patient's level of activation; for example, those with low activation can become overwhelmed with information, and need to be approached with small pieces of information repeatedly, focusing on small goals 3 .…”

Section: Discussionmentioning

confidence: 99%

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Changes in patient activation in people starting dialysis: A prospective longitudinal, observational study

Hussein

Hemodialysis International

Carrasco

et al. 2022

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Introduction: Increased patient activation is associated with improved health outcomes; however, little is known about patient activation in people with end-stage kidney disease at the start of their dialysis journey. This study aimed to measure activation status changes over the first 4 months of dialysis.Methods: Prospective, longitudinal, and observational study. Incident patients initiating dialysis at 25 in-center hemodialysis and 17 home dialysis programs across three US states managed by the same dialysis provider completed the 13-item Patient Activation Measure (PAM-13) survey at baseline (month 1 after commencement of dialysis) and follow-up (month 4). The survey yields a score (0-100) that corresponds to four levels (1-4), with higher scores or levels indicating higher activation.Findings: One hundred eighty-two participants (139 center, 43 home) completed both baseline and follow-up surveys. Mean age was 60 AE 15 years, 40% female. Mean PAM-13 scores were 65.1 AE 16.8 and 64.8 AE 17.8 at baseline and follow-up, respectively; mean intraindividual change: À0.3 AE 17.3. The proportions of patients at levels 1-4 at baseline were 11%, 23%, 35%, and 31% respectively. At follow-up, 50%, 64%, 52%, and 37% of participants at levels 1-4, respectively, changed to a different PAM level (Spearman correlation = 0.47; p < 0.001). Home dialysis was associated with higher PAM scores when compared to in-center hemodialysis in multivariable analyses, adjusted for sociodemographic variables, comorbidities, and predialysis nephrology care (β = 5.74, 95% confidence intervals [CI]: 0.11-11.37 and 9.02, 95% CI: 3.03-15.02, at baseline and follow-up, respectively).Discussion: Although aggregated group scores and levels remained stable, intra-individual patient activation changed significantly during the first 4 months of dialysis. This novel finding is foundational to future projects aiming to design interventions to improve patient activation.

“…It is likely that one isolated specific individual strategy may not be sufficient to increase patient activation with a combination of the following strategies required. A combination of individualized care plans; scenario-based education, health coaching with motivational interviewing; goal setting with a systematic follow up to assist patients to improve the skills to maintain life changes needed and handle health-related complications; and tailored coaching by peers to help patients building confidence in how to follow healthcare recommendations may increase patient activation ( 54 ).…”

Section: Discussionmentioning

confidence: 99%

Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study

Hussein

Journal of Patient Experience

Sun

et al. 2022

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Patient activation is the product of knowledge, skills, and confidence that enables a person to manage their own healthcare. It is associated with healthy behaviors and improved patient outcomes. We surveyed prevalent hemodialysis (HD) patients at 10 centers using the Patient Activation Measure 13-item instrument (PAM-13). Activation was reported as scores (0-100) and corresponding levels (1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92% response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was 41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with 14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis, older age and having diabetes were associated with lower activation, whereas higher educational levels and female gender were associated with higher scores. Significant variation in activation was observed among participants from different centers even after adjustment for other variables. In conclusion, low activation is common among prevalent HD patients.