Article Figures & Data
Tables
Characteristic Top-Performing Clinicians (n = 10) Bottom-Performing Clinicians (n = 10) Patientsa Change in PAM score Mean 7.5 3.1 Median 5.5 1.3 Chronic conditions, mean No.b 0.6 0.7 Emergency department visits,c mean No. 0.3 0.3 Hospitalizations,c mean No. 0.1 0.1 Clinicians Sex Male, No. 3 7 Female, No. 7 3 Type of clinician Family practitioner, No. 7 5 Internist, No. 1 2 Internist/pediatrician, No. 1 2 Nurse practitioner, No. 1 0 Physician assistant, No. 0 1 PAM = patient activation measure (scores range from 1 to 100, with higher scores indicating greater activation).
↵a Among those having 2 PAM scores.
↵b Diabetes, asthma, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, and depression.
↵c At Fairview Health Services in the baseline year.
Strategy Clinicians Reporting Strategy, No. Top-Performing Clinicians (n = 10) Bottom-Performing Clinicians (n = 10) Used mainly by top-performing group Emphasizing patient ownership 8 3 Partnering with patients 9 3 Identifying small steps 10 3 Scheduling frequent follow-up visits 7 3 Showing caring 5 1 Used by both groups Reliance on team supports 10 7 Used mainly by bottom-performing group Describing consequences of bad health behaviors 2 8
Additional Files
The Article in Brief
Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels
Jessica Greene , and colleagues
Background Patient activation (the knowledge, confidence, and skills to take care of one?s health and healthcare) is associated with health-related outcomes. This study aims to shed light on clinician behaviors that support greater activation and how these behaviors are associated with better outcomes.
What This Study Found Exemplar physicians use five key strategies to support patient behavior change. They, 1) emphasize patient ownership; 2) partner with patients; 3) identify small steps; 4) schedule frequent follow-up visits to cheer successes, problem solve, or both; and 5) show care and concern for patients. Clinicians whose patients have low activation are far less likely to describe using these approaches.
Implications
- Given the key role patients play in determining health outcomes, it is critical that primary care physicians support patient self-management and activation. The authors call for more systematic professional and organizational approaches to help clinicians adopt evidence-based strategies to support patients and increase activation levels.