Using health coaching and the Patient Activation Measure® to support self-management within musculoskeletal outpatients: A service improvement project

ABSTRACT

Keywords Health Coaching;Self-management;Patient Activation Purpose: Due to the Covid-19 pandemic primary care musculoskeletal (MSK) services within the National Health Service (NHS) were reduced following staff redeployment and restrictions to face-to-face services. Therefore, a local strategy to manage MSK waiting lists was required. The aims of this project were to involve patients in decision making early within their care pathway, understand their level of activation (knowledge, skills and confidence in self-management) and agree an action plan to support their self-management. Methods: This was a service improvement project within one NHS adult outpatient MSK service. Patients on the routine waiting lists for advanced practice or usual physiotherapy and osteopathy appointments were contacted to book a consultation and were asked if they consented to completing the Patient Activation Measure® (PAM®). Clinicians (10 physiotherapists and one podiatrist) who had undergone brief health coaching training telephoned the patients and used the T-GROW (Topic, Goal, Reality, Options and Way forward) model to frame the conversation and shared decision making to establish a management plan. Clinicians were aware of the patient's PAM® score prior to calling. They provided feedback on their experience of the calls and the usefulness of the PAM® score for informing their decisions. A patient partner (expert by experience) called a sample of patients who consented to follow up to capture their experience. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Results: Data were collected for 568 patients. The average consultation duration was 21.5 min. The PAM® was completed for 278 patients (49%). PAM® scores for these patients were 1 (low activation) n = 24 (9%);2 n = 67 (24%);3 n = 100 (36%);4 (high activation) n = 87 people (31%). Reasons for not completing the PAM® included time and language barriers. Following the calls 105 people (18.4%) were discharged to self-manage with exercises, self-care information or signposted to other services. Seventy-two percent of these patients had higher levels of activation (PAM® score 3 or 4). Other outcomes included 16 people being referred to secondary care and 14 people having medical imaging arranged. Patients who remained on the waiting list received reassurance and information about their condition. Clinician feedback highlighted the benefit of establishing expectations, providing reassurance, signposting to other services and facilitating self-management. In 79% of consultations clinicians felt that the PAM® score accurately reflected the patient's knowledge, skills and confidence. All 9 patients who gave feedback said the call helped them to clearly understand their management plan and most patients were highly satisfied with the call although some expected a face-to-face service. Conclusion(s) Calling patients early in the MSK care pathway using a health coaching framework with knowledge of their PAM® score helped to determine patient expectations, support self-management and signpost to wider community resources. Impact This project helped to respond to service demands during the Covid-19 pandemic and offers an innovative approach to involving patients in their care pathway at an earlier stage which could be further evaluated through both qualitative and quantitative research. Funding acknowledgements This work was not funded and was part of the services for Sussex Musculoskeletal Partnership.