title: Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels.
abstract: OBJECTIVE
  We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation.
  
  
  METHODS
  This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores.
  
  
  RESULTS
  Clinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation.
  
  
  CONCLUSIONS
  Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.
authors.affiliation: School of Nursing, George Washington University, Washington, DC jessgreene@gwu.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
authors.affiliation: ISE Health Policy Group, University of Oregon, Eugene, Oregon.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Hibbard
authors.affiliation: School of Nursing, Department of Community-Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Carmen
authors.initials: C
authors.lastname: Alvarez
authors.affiliation: Fairview Medical Group, Minneapolis, Minnesota.
authors.forename: Valerie
authors.initials: V
authors.lastname: Overton
mesh_terms: D003299:Cooperative Behavior; D003376:Counseling; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D012648:Self Care / Q000379:methods*
keywords: behavior change; health behavior; mixed methods research; motivation; patient activation; patient empowerment; physicians’; practice patterns; practice-based research; primary care; self-management