• 30Aug

    Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy

    A cross-sectional analysis of electronic health records in the BMJ:

    The objective was to quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy.

    12270 PAM questionnaires were returned from 9348 patients. In the adjusted analyses, compared with the least activated group, highly activated patients (level 4) had the lowest rate of contact with a general practitioner (rate ratio: 0.82, 95% CI 0.79 to 0.86), emergency department attendances (rate ratio: 0.68, 95% CI 0.60 to 0.78), emergency hospital admissions (rate ratio: 0.62, 95% CI 0.51 to 0.75) and outpatient attendances (rate ratio: 0.81, 95% CI 0.74 to 0.88). These patients also had the lowest relative rate (compared with the least activated) of ‘did not attends’ at the general practitioner (rate ratio: 0.77, 95% CI 0.68 to 0.87), ‘did not attends’ at hospital outpatient appointments (rate ratio: 0.72, 95% CI 0.61 to 0.86) and self-referred attendance at emergency departments for conditions classified as minor severity (rate ratio: 0.67, 95% CI 0.55 to 0.82), a significantly shorter average length of stay for overnight elective admissions (rate ratio 0.59, 95% CI 0.37 to 0.94),and a lower likelihood of 30- day emergency readmission (rate ratio: 0.68 , 95%  CI 0.39 to 1.17), though this did not reach significance.

    They conclude that the rising demand for healthcare services, a large proportion of which is due to the growing population of people with long-term conditions, has led to a need to manage the increasing pressure placed on primary and secondary care. In this paper, we found that more activated patients used healthcare services less often, even after controlling for predictors of utilisation, such as diagnosed physical and mental health long-term conditions, gender, age and socioeconomic deprivation. Our findings suggest that supporting patients with long-term conditions to manage their own care is not only a key part of high-quality care but could be associated with lower healthcare utilisation. This is particularly important at a time when health services are under strain.

    Read the full article here: https://qualitysafety.bmj.com/content/early/2018/07/09/bmjqs-2017-007635