Outcomes of a 12-month patient-centred medical home model in improving patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia: A before-and-after study.

Abstract

Background: Studies report that increased patient activation is associated with increased patient engagement with the health care system, better adherence to treatment protocols, and improved health outcomes. This study aims to evaluate outcomes based on a 12-month Patient-Centred Medical Home (PCMH) model called ‘WellNet’ on activation levels of patients with one or more chronic diseases in general practices across Sydney, Australia.Methods: A total of 636 patients aged 40 years and above with one or more chronic conditions consented to participate in the WellNet program delivered across six general practices in Northern Sydney, Australia. The WellNet treatment includes a team-based care with general physicians and trained chronic disease management care coordinators collaborating with patients in designing a patient-tailored care plan with improved self-management support and care navigation according to the level of risk and health care needs. Level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A before and after case-series design was employed to determine adjusted differences between baseline and 12-months using repeated measures analysis of covariance (ANCOVA). Multiple imputation was used to compute missing follow-up scores using Markov Chain Monte Carlo (MCMC) algorithm known as fully conditional specification (FCS). Additionally, backward stepwise multivariate regression models were employed to identify significant predictors of activation at follow-up.Results: Of the 626 patients, 420 reported their PAM scores at follow-up. The mean (SD) baseline PAM score was 57.9 (13.0). The adjusted model showed significant mean difference in PAM scores of 6.5 (95% CI 5.0-8.1; p-value<0.001) after controlling for baseline covariates. Multivariate regression models showed that older age (B = -0.14; 95% CI -0.28, -0.01), baseline activation score (B = 0.48; 95% CI 0.37, 0.59), and private insurance (uninsured patients) (B = -3.41; 95% CI -6.50, -0.32) were significant predictors of patient activation at follow-up.Conclusion: The WellNet study is the first of its kind in Australia to report on changes in the patient activation levels among patients with one or more chronic diseases. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.