The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review.
OBJECTIVE
A systematic review of the published literature on the association between the PAM (Patient Activation Measure) and hospitalization, emergency room use, and medication adherence among chronically ill patient populations.


METHODS
A literature search of several electronic databases was performed. Studies published between January 1, 2004 and June 30, 2014 that used the PAM measure and examined at least one of the outcomes of interest among a chronically ill study population were identified and systematically assessed.


RESULTS
Ten studies met the eligibility criteria. Patients who scored in the lower PAM stages (Stages 1 and 2) were more likely to have been hospitalized. Patients who scored in the lowest stage were also more likely to utilize the emergency room. The relationship between PAM stage and medication adherence was inconclusive in this review.


CONCLUSIONS
Chronically ill patients reporting low stages of patient activation are at an increased risk for hospitalization and ER utilization.


CONCLUSIONS
Future research is needed to further understand the relationship between patient activation and medication adherence, hospitalization and/or ER utilization in specific chronically ill (e.g. diabetic, asthmatic) populations. Research should also consider the role of patient activation in the development of effective interventions which seek to address the outcomes of interest.
Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA. Electronic address: rebecca.kinney@umassmed.edu.
Rebecca L
RL
Kinney
Department of Medicine, University of Massachusetts, Medical School, Worcester, USA.
Stephenie C
SC
Lemon
Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA.
Sharina D
SD
Person
Department of Medicine, University of Massachusetts, Medical School, Worcester, USA.
Sherry L
SL
Pagoto
Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA; Department of Medicine, University of Massachusetts, Medical School, Worcester, USA.
Jane S
JS
Saczynski
D002908:Chronic Disease / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010358:Patient Participation; D018802:Patient-Centered Care / Q000379:methods; D011787:Quality of Health Care; D016903:Drug Monitoring
Chronic illness; ER utilization; Hospitalization; Medication adherence; Patient activation measure (PAM); Patient centeredness