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Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records
  1. Isaac Barker,
  2. Adam Steventon,
  3. Robert Williamson,
  4. Sarah R Deeny
  1. Data Analytics, The Health Foundation, London, UK
  1. Correspondence to Dr Sarah R Deeny, Data Analytics, The Health Foundation, London WC2E 9RA, UK; Sarah.Deeny{at}


Objective To quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy.

Results 12 270 PAM questionnaires were returned from 9348 patients. In the adjusted analyses, compared with the least activated group, highly activated patients (level 4) had the lowest rate of contact with a general practitioner (rate ratio: 0.82, 95% CI 0.79 to 0.86), emergency department attendances (rate ratio: 0.68, 95% CI 0.60 to 0.78), emergency hospital admissions (rate ratio: 0.62, 95% CI 0.51 to 0.75) and outpatient attendances (rate ratio: 0.81, 95% CI 0.74 to 0.88). These patients also had the lowest relative rate (compared with the least activated) of ‘did not attends’ at the general practitioner (rate ratio: 0.77, 95% CI 0.68 to 0.87), ‘did not attends’ at hospital outpatient appointments (rate ratio: 0.72, 95% CI 0.61 to 0.86) and self-referred attendance at emergency departments for conditions classified as minor severity (rate ratio: 0.67, 95% CI 0.55 to 0.82), a significantly shorter average length of stay for overnight elective admissions (rate ratio 0.59, 95% CI 0.37 to 0.94),and a lower likelihood of 30- day emergency readmission (rate ratio: 0.68 , 95%  CI 0.39 to 1.17), though this did not reach significance.

Conclusions Self-management capability is associated with lower healthcare utilisation and less wasteful use across primary and secondary care.

  • chronic disease management
  • emergency department
  • general practice
  • health policy

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  • Contributors AS and SRD conceived the study. IB, AS and SRD designed the statistical analysis plan. SRD, IB and RW carried out the analysis. IB, SRD and AS drafted and finalised the paper.

  • Funding All authors had financial support from The Health Foundation for the submitted work.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement PAM questionnaires were collected as part of routine care and uploaded to the electronic health record. As we used routinely collected and pseudonymised data for our analysis, with a data sharing agreement approved by the Islington CCG data holders, no further ethics approval was required. However, due to the data sharing agreement, data cannot be made publicly available with this study.