The Association between Patient Activation and Outcomes among Severely Mentally Ill Patients
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ess correspondence to Charles Ruetsch, PhD, Health Analytics, LLC 9200 Rumsey Rd Suite 215, Columbia, MD 21045, USA. Email: [email protected]. Felicia Forma, BSc, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ 08540, USA. Jennifer Clerie, BS, Health Analytics, LLC 9200 Rumsey Rd Suite 215, Columbia, MD 21045, USA. Tigwa Davis, PhD, Health Analytics, LLC 9200 Rumsey Rd Suite 215, Columbia, MD 21045, USA. Kelly Clovie, MS, Health Analytics, LLC 9200 Rumsey Rd Suite 215, Columbia, MD 21045, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–17. c 2020 The Author(s). DOI 10.1007/s11414-02009731-3
Activation and Outcomes among SMI Patients
FORMA ET AL.
Introduction Serious mental illness (SMI), including schizophrenia (Sz), bipolar disorder (BD), and major depressive disorder (MDD), affect approximately 4.5% of the adult US population.1 These diseases are often difficult to treat and are associated with elevated healthcare cost, which is largely driven by relapse events.2–8 Although only a small percentage of individuals are impacted by these disorders, healthcare costs to treat SMI patients are estimated at $148 billion annually and account for approximately 10% of total annual direct healthcare costs in the USA.1 As is the case for primary healthcare, treatment of mental health disorders is moving from a paternalistic model to one that places greater emphasis on patient involvement and engagement in their own personalized treatment regimens.9,10 In primary care, high levels of patient activation, defined as “a patient’s willingness and ability to take independent actions to manage their health and care,”11 p207 are associated with a lower cost of care likely driven by increased use of both healthy behaviors and preventative care.11,12 Further, increases in patient activation are associated with stepwise improvements in health outcomes including clinical indicators, medication adherence, and health-related quality of life (HRQoL).11 Patients with severe mental illness often face greater behavioral and personal care challenges. Nevertheless, they show interest in and actively engage their healthcare providers and collaborate in shared healthcare decision-making in both primary care as well as mental healthcare.13,14 Accordingly, the few studies of patient activation among SMI populations mirror studies conducted among patients with chronic physical diseases, like cardiovascular disease and diabetes. For example, increased levels of patient activation are associated with increased self-management behavior and reduced substance abuse.15 Similarly, participation in health-focused intervention programs increases patient activation levels and results in increased adherence, improved HRQoL, and greater use of primary care services among SMI populations.16 These findings suggest that increased activation among SMI patients may be associated with improved health outcomes and reduced overall cost of care. Decreases in healthcare costs in activated populations are expected to
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