Person Centred Care and using the Patient Activation

Person Centred Care and using the Patient Activation Measure in Sheffield Eileen Hall Sheffield CCG eileen. hall 3@nhs. net Thanks to Dr Ollie Hart Oliver. hart@nhs. net Hazel Blackbourn PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

• What do you want to know ? • What's been your experience ? • 10 minute chat on the table • 1 or 2 questions form each table PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

What I’m going to talk about Person centred care Activation How the CCG has supported GP practices New ways of doing long term condition management • Your involvement as Individuals/PPGs • • PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Strategic Drivers Getting serious about prevention Empowering patients Engaging communities The NHS as a social movement PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

6 principles of person-centred care Care and support is personalised, coordinated, empowering Services are created in partnership with citizens and communities Improved health and wellbeing Services focus on narrowing inequalities Carers are identified, supported, involved Empowering people and communities Voluntary sector, community and social enterprise are key partners Volunteering and social action are key enablers Improved care and quality PPG Meeting 14 June 2018 eileen. hall 3@nhs. net Improved efficiency and finances

Why focus on long-term conditions • People with LTCs are the most frequent users of healthcare services. • 35% of people with LTCs have low or very low levels of knowledge, skills and confidence to self care in order to manage their health and wellbeing and to live independently. • These people tend to develop more long term conditions, have a poorer quality of life, make more unwarranted use of public services and cost more to public services than people at higher levels of activation. PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Who makes the most important contribution to successful LTC management? The Healthcare System Patients themselves Confidence, Knowledge and Skills PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

The importance of patient selfmanagement is well established Source: World Health Organization. Commission on Social Determinants of Health Final Report 2007 PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Self management is usual care PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Patient Activation: Possessing the skills, knowledge and confidence to actively engage in your health and change behaviours where needed to achieve better health outcomes PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

What is the PAM? • The Patient Activation Measure (PAM) is… • A questionnaire designed to measure the confidence, knowledge and skills (ACTIVATION) that a person has to manage their own health and healthcare. PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

How was PAM developed? • 2000 -2004 • 18 expert professionals & patients/ Literature – Domains • 480 purposefully selected- range of conditions – Questions refined and tested • 1500 general public- phone survey – Validated, reliable, consistent • 22 questions 13 10

An extensive base of research validates PAM and informs our approach to increasing patient activation PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

What 12 years of research across 25 countries suggests… • More highly activated patients… • • • Make more informed choices. Are better with self-management and prevention. Partner in their care. Use less healthcare resource. Report higher Qo. L Are more satisfied with care they receive. PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

What does measuring blood pressure allow us to do? • • Get a diagnosis – starting point Predict risk of CVD (with other factors) Tailor interventions/treatments Allocate resources PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

A PAM score is predictive of utilisation and outcomes Diabetes Patients % change for 1 point change in PAM score For illustration 10 point gain impact 54 (L 2) to 64 (L 3) 1. 7% decline 17% decrease likelihood of hospitalisation Good A 1 c control (Hg. A 1 c <8%) 1. 8% gain 18% greater likelihood of good glycemic control A 1 c testing LDL-c testing 3. 4% gain 34% improvement in testing Hospitalisation Source: Is Patient Activation Associated with Future Health Outcomes and Healthcare Utilization Among Patient with Diabetes? Journal of Ambulatory Care Management Oct/Dec 2009 -A single point change in activation is meaningful -5 point change associated with behaviour change Copyright © 2016 Insignia Health

Four activation levels reside along a continuum Activation is developmental Level 4 Level 3 Level 2 Level 1 Becoming aware, but still struggling Overwhelmed & disengaged 20 -30% 10 -20% 10 Taking action & achieving many behaviours at guideline levels 20 30 40 20 -30% 25 -35% 50 60 70 80 Maintaining behaviours and pushing further 90 0 -100 point empirically derived point scale Allows us to understand how an intervention specifically impacts a change in PAM score PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Understanding a person’s underlying selfmanagement ability unlocks a wealth of insight Like the roots of a tree, activation is not easily observed, but fundamental to growth in a person’s self-management ability. PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Health Coaching provides Copyright © 2016 Insignia Health

What’s in it for me? • Patient – meeting you where you are • Clinician – Best use of time – knowing what not to do – Marker of progress • Commissioners – best use of resources PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

How might you allocate resources? A C T I V A T I O N Well controlled, High Activation Leave alone- letter Recruit peer support Well controlled, Low Activation Prevention Voluntary sector/CSW Poor control, High Activation Health Coaching GP/Nurse Poor control, Low Activation Easily overwhelmed Build confidence and Importance Making sense of life Social prescribing Medical Control PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Sheffield CCG: Person Centred Care… The story so far …. . PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

• Year 1 : Learning • Care Planning • Practice paid per plan • Patients and Staff little knowledge • Year 2 : Education and Measurement • • Back to the basics Why, what, how Activation as concept of capability to self manage Care planning as a tool to develop PCC Introduced PAM as a measure PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Year 3 : Ownership Year 4 and 5? . . . • Practices make their own plans • Reflective learning- what works • Measures and Case stories • • Neighbourhood/ community engagement Developing local and community resources Building on our learning in primary care across the health and social care system Opportunities from ACP / 5 YFV/ Self care PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Patient Feedback PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Patient Feedback PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Defining a Person Centred City No single definition… but at the core ‘It is about putting the person at the heart of every decision and empowering them to be genuine partners in pursuing what matters to them’ ‘It’s about having systems that support us to make informed decisions; help us to successfully manage our own wellbeing and delivers care (when needed) with respect for our individual abilities, preferences, lifestyles and goals’ ‘Systems in which people feel in control, valued, motivated and supported’ PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Summing up- Individualised partnerships • Person Centred Care – deliberate approach to personalise, co-ordinate, enable care • Coaching Approach- an underlying ethos and way of interacting for consultations and system development • Activation- developing tailored interventions and segmenting care for best outcomes PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

Summary • Activation and PAM are key features of Person Centred approaches • Build on assets, meet people where they are – Patients – Clinicians – No one size fits all • Mindset shifting - coaching PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

PPG Meeting 14 June 2018 eileen. hall 3@nhs. net

• Ask your practice… • Are they involved in the locally commissioned service? • How do I get a PAM? • What are we doing in our practice to support Patient Centred Care? PPG Meeting 14 June 2018 eileen. hall 3@nhs. net