Patient Compliance Techniques That Work

February 25, 2011

Patient Compliance Techniques That Work

While demographic factors — including age, sex, race, education, and socioeconomic status — appear not to influence adherence levels significantly, research suggests there are certain behaviors that play a role. For example, “many patients with a low level of activation have poor problem-solving skills,” says Judith Hibbard, professor of health policy at the University of Oregon, who co-developed a self-assessment tool to categorize patients by how active they are likely to be in their own healthcare. “If the pharmacy is closed or [the patient’s] copayment goes up, they’re more likely to give up,” she says. “Any barrier thrown in their path can throw them off, so knowing that is helpful in terms of making sure those patients get the help they need.”  

Hibbard’s Patient Activation Measure, or PAM, uses 13 questions to assess patients’ knowledge, skills, and confidence for managing their health. It produces a score of 0 to 100 and breaks out patients into four progressively higher activation levels. Each level is associated with distinct self-care behaviors and attitudes — the values, motivations, and emotional dispositions that drive those behaviors. The score is sent directly to the physician or healthcare provider.  

“Physicians can use [the score] in medical homes as a way to personalize care, consistent with the patient’s level of activation,” says Hibbard, noting that staff could ask patients to fill out the survey in the waiting room before they’re seen. “If they’re low activated, they may feel overwhelmed and discouraged because they’ve had a lot of experience with failure in trying to manage their health. So the physician knows that instead of giving them a list of 17 things, they should start small. Give [patients] permission to focus on one thing first, so you build their confidence and set them up for success.”  

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