Activating people to partner in health and self-care: use of the Patient Activation Measure.

Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual's knowledge, skill and confidence for managing their health and health care. Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re-admissions. Patients with lower activation levels (25-40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation. Effective interventions can improve a patient's activation level, and positive change in activation equates to positive change in self-care behaviour. But to improve patient activation, we must first measure it using a robust evidence-based tool such as the Patient Activation Measure (PAM) survey. Armed with the patient's PAM score, providers can tailor their care and help patients achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation. The PAM is also useful for population segmentation and risk stratification - to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions. The role of patient activation requires further serious consideration if we are to improve the long-term health and wellbeing of all Australians. The PAM tool is a feasible and cost-effective solution for achieving the Quadruple Aim - improving population health, the cost-efficiency of the health system, and patient and provider experience.

Why do people with long-term health needs see more than one GP?: a qualitative study.

This study aimed to understand what barriers exist or choices are made by patients who access regular care for long-term health issues from multiple GPs. This was a qualitative interview study in Western Sydney community settings consisting of semi-structured interviews and inductive thematic analysis. Twenty participants who accessed GP care were interviewed. Sixteen had seen multiple GPs over the previous twelve months and all had seen multiple GPs over preceding years. Participants valued interpersonal continuity of care. Nevertheless, they made decisions to meet their needs by seeing multiple GPs. They considered waiting times, preference for an individual GP based on their consultation style or perception of their particular area of expertise, experiences with reception staff and the practice model of care. Participants were aware that interpersonal continuity of care was considered important by GPs and were reticent to be seen as 'doctor shoppers'. Therefore, they did not usually disclose that they saw multiple doctors and were unlikely to discuss continuity of care with a GP. Participants made considered choices about health care. Despite general practice promoting interpersonal continuity of care, it is not always achievable or desired by patients. GPs can promote care continuity through supportive practice models and dialogue about when continuity is desirable.

Assessment of environmentally persistent free radicals in soils and sediments from three Superfund sites.

We previously reported the presence of environmentally persistent free radicals (EPFRs) in pentachlorophenol (PCP) contaminated soils at a closed wood treatment facility site in Georgia. The reported EPFRs were pentachlorophenoxyl radicals formed on soils under ambient conditions via electron transfer from PCP to electron acceptors in the soil. In this study, we present results for soil and sediment samples from additional Superfund sites in Montana and Washington. Paramagnetic centers associated with different chemical environments were characterized by distinct g-factors and line widths (ΔHp-p). EPFR concentrations in contaminated samples were ~30×, ~12×, and ~2× higher than background samples at the Georgia, Montana, and Washington sites, respectively. EPR signals in the Montana contaminated soils were very similar to those previously observed for pentachlorophenol contaminated soils at the Georgia site, i.e., g = 2.00300 and ΔHp-p = 6.0 G, whereas signals in the Washington sediment samples were similar to those previously observed for other PAH contaminated soils, i.e., g = 2.00270 and ΔHp-p = 9.0 G. Total carbon content measurements exhibited direct correlation with EPFR concentration. The presence of radicals in sites contaminated a decade to a century ago suggests continuous formation of EPFRs from molecular contaminants in the soil and sediment.