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rates of hospitalization. On the other hand, patients with low activation levels are
more likely to attend accident and emergency departments, to be hospitalized, or to
be re-admitted to hospital after being discharged. This is likely to lead to higher
healthcare costs.
The Patient Activation Measure tool has been designed to assess an individual’s
knowledge, skill, and confi dence for self-management. It was developed by Hibbard
and colleagues in 2004 originally as a 22-item scale, the PAM 22, and subsequently
as a 13-item short form [ 56 , 57 ]. The PAM’s 13-item scale asks people about their
beliefs, knowledge, and confi dence for engaging in a wide range of health behaviors
and then assigns an activation score based on their responses to the 13-item scale.
The tool was formulated in two versions targeted at people with or without chronic
disease, with few reported semantic differences. The authors also reported that the
measure has good psychometric properties, indicating that it can be used at the indi-
vidual patient level to tailor interventions and assess changes. Hibbard and col-
leagues [ 56 ] identifi ed four elements—knowledge, skills, confi dence, and
behaviors—that are critical for coping with a chronic illness, and suggested 4 stages
of activation that patients go through on their way to becoming fully activated in
managing their own health.
Positive changes in patient activation were reported as able to lead to positive
self-management behavior changes in patients with chronic conditions [ 57 ].
Intervening to increase activation can improve a patient’s engagement and health
outcomes and is an important factor in helping patients to manage their health.
Patient activation interventions have been developed for patients with cancer, diabe-
tes, hypertension, obstetrical and gynecological issues, and end-stage renal disease,
as well as osteoarthritis [ 58 ]. Improvements in patient activation scores have been
seen for up to 18 months following intervention. In concordance, tailoring services
provided to the patient’s activation levels can maximize productivity and effi ciency
by safeguarding that the level of support provided is appropriate to the needs of the
individual [ 59 ]. Therefore, patient activation measure provides a new insight into
risk that goes beyond those attained using the traditional sociodemographic factors
as it provides a unique measure of engagement and empowerment that can be used
to appraise the effectiveness of interventions and to measure the performance of
healthcare organizations in involving patients in their own care.
Conclusion
Whilst patients’ assessment for their perceived needs/priorities is important, PROMs
questionnaires can help clinicians identify their patients’ educational requirements.
In fact, PROMs can be the link between the needs-based and clinical-based patient
education activity. PROMs also enable the treating healthcare professional to meet
the expanding scope of patient education, which has gone beyond disease activity to
include disability, quality of life, as well as disease-associated comorbidities. Routine
use of PROMs has the potential to help transform arthritis treatment toward a tar-
geted management approach tailored to the patient’s needs.
D. Palmer and M. Ndosi