Online Program

Understanding patient-provider relational contributors to patient activation

Tuesday, November 5, 2013 : 10:50 a.m. - 11:10 a.m.

Michele L. Allen, MD, Family Medicine, University of Minnesota, Minneapolis, MN
Benjamin L. Cook, PhD, Health Equities Research Lab / Center for Multicultural Mental Health Research, Harvard Medical School, Cambridge, MA
Alejandro Interian, PhD, VA NJ Health Care System, Lyons, NJ
Nicholas Carson, MD, Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA
Martin La Roche, Ph.D., Martha Eliot Health Center, Children's Hospital Boston/Harvard Medical School, Jamaica Plain, MA
Margarita Alegria, PhD, Psychiatry--Center for Multicultural MH Research, Harvard Medical School, Somerville, MA
Objective: Patient activation, which has been associated with improved health outcomes, has been conceptualized as an individual attribute describing a patient's ability to self-manage his or her own health care. The contribution of patient-provider relational factors such as therapeutic alliance to patient activation remains underexplored, particularly in the community mental health setting and through longitudinal studies. Our purpose is to estimate the association between therapeutic alliance and patient activation as assessed by the Patient Activation Measure (PAM) over time. Design: Participants were from the control group (n=264) of the DECIDE intervention. We evaluated unadjusted and adjusted PAM scores at baseline and follow up, considering the contribution of therapeutic alliance. We controlled for sociodemographic variables and clinical characteristics such as diagnosis and length in treatment. Participants: Patients were recruited from 13 community-based mental health clinics across the United States. Results: Participants were 69% women, 65% Latino, and 56% non-US born. Unadjusted PAM scores generally were higher at follow-up. Therapeutic alliance emerged as a significant and independent predictor of greater PAM scores at baseline and at follow-up, even after adjustment. Implications: Despite being generally conceptualized as an individual trait, patient activation partially depends on the interaction between patient and provider. Interventions to increase patient activation should consider how improving patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care may contribute to patients' ability to manage their own mental health and mental health care.

Learning Areas:

Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health administration or related administration

Learning Objectives:
Describe baseline patient activation and change scores for a diverse population of participants receiving mental health care in community clinics. Assess the independent contribution of therapeutic alliance to patient activation at baseline and at follow-up after controlling for sociodemographic and clinical variables. Discuss the implications of results for interventions focused on increasing patient activation.

Keyword(s): Mental Health Services, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been site-investigator on the DECIDE study, as well as PI on multiple other NIH funded studies, and have clinical and research expertise in care delivery for diverse populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.