It has long been a conundrum of healthcare that while we know as fact
that every person’s health and wellbeing is unique, the system has to
be cautious and treat everyone nearly the same. This causes resources
to be wasted and patients to potentially get poorer outcomes as some
get more support than they need, while others don’t get enough.
As a result, tools that help the NHS to confidently deliver
person-centred care are keenly sought. NICE now routinely includes
patient-centred care in all their guidelines and among the most well
validated approaches, the ‘Patient Activation Measure’ (PAM), is being
rolled out in pilot sites by NHS England. AbbVie is also using it to
tailor our AbbVie Care support programme, and recently cohosted a
meeting with the Kings Fund to shed more light on the potential of PAM.
Even people with serious long term conditions only have fleeting
moments to talk with healthcare professionals. One of the speakers at
the conference who had lived with kidney disease and spent years on
dialysis stated that over the course of his illness the time he spent
getting advice from a medical professional probably added up to little
more than four hours a year – the other 8760 hours a year he was on
his own. For most people, we talk to clinicians even less and it is
our own resourcefulness and confidence that has a major bearing on
speed and quality of recovery or lived experience of an ongoing illness.
Completing a PAM questionnaire gives a strong indication of where an
individual is at in terms of the level of support they need. It offers
a grading from level 1 where an individual feels overwhelmed and out
of control of their health to level 4 where they are the expert in
their own illness and can self-manage their own condition. Repeating
the survey enables health services to track how confidence is faring
This matters to the NHS because those with higher PAM scores are
associated with lower cost per patient and that proper use of
medicines (adherence) improves the higher up the scale a patient goes.
Identifying who needs help the most via PAM grading enables better
targeting of support resources. Speakers at the event suggested some
interesting potential strategies for helping patients get increasingly
knowledgeable and confident. While the temptation might be to focus
intensively on those at level 1, speakers suggested this would only
increase the sense of being overwhelmed. This group needs small steps
of encouragement. Where the biggest potential for improved outcomes
and reduced costs could exist is in prioritising support resources for
those in the middle.
Despite these positive benefits there are barriers to the full
potential being realised. One of these is that PAM has a PR problem.
The very name itself is a form of jargon that can be alienating for
patients (who thinks of themselves as ‘activated’?) and using plain
English to describe the measure would help it be better understood.
There is also some inertia from doctors. NHS England estimate that 85
per cent of medics already believe they doing shared decision making
and giving patients the right information which is not reflected in
the opinions given by the patients they are engaging with and another
speaker quoted surveys that more than two thirds have moderate to low
faith in the PAM.
What is clear from the enthusiasm and advice of speakers at the
Kings Fund event is that the potential is there as long as PAM
measurement isn’t considered as a performance measure but as a means
to drive smarter commissioning decisions and social policy to
encourage patient self-management and the benefits to all that unlocks.
To watch the highlights of the event click here