Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

Abstract

PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation.METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTSClinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation.CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness. 2016;14:148-154. doi:10.1370/afm.1904. Ann Fam Med INTRODUCTIONT hrough policies such as pay for performance and public reporting of clinicians' quality of care, clinicians are increasingly responsible for their patients' care outcomes. [1][2][3][4] Yet, for health outcomes to improve, patients must do their part, following through on treatment regimens and making recommended lifestyle changes.5-7 Given the key role that patients play in determining health outcomes, policy makers have made patient engagement and patient activation a major focus, including embedding approaches for increasing engagement in the Patient Protection and Affordable Care Act. 8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with hig...

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