eprintid: 10137929 rev_number: 16 eprint_status: archive userid: 608 dir: disk0/10/13/79/29 datestamp: 2021-11-09 11:06:09 lastmod: 2021-12-02 23:21:08 status_changed: 2021-11-09 11:06:09 type: article metadata_visibility: show creators_name: Bu, F creators_name: Fancourt, D title: How is patient activation related to healthcare service utilisation? Evidence from electronic patient records in England ispublished: pub divisions: UCL divisions: B02 divisions: D12 divisions: J96 note: © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. abstract: Background: There is increasing awareness of the importance of patient activation (knowledge, skills, and confidence for managing one’s health and health care) among clinicians and policy makers, with emerging evidence showing higher levels of patient activation are associated with better health outcomes and experiences of health care. This study aimed to examine the association between patient activation and a wide range of specific types of healthcare service utilisation in England, including GP and non-GP primary care, elective and emergency hospital admissions, outpatient visits, and attendances at the Accident and Emergency department. Methods: Data were derived from linked electronic patient records collected by primary and secondary healthcare providers in North West London between January 2016 and November 2019. Our analyses focused on adults (18+) with a valid Patient Activation Measure (PAM). After excluding patients with missing data, we had an analytical sample of 15,877 patients. Data were analysed using negative binomial regression and logistic regression models depending on the outcome variable. Results: Patients had a mean activation score of 55.1 and a standard deviation (SD) of 17.7 (range: 0–100). They had an average of 5.4 GP visits (SD = 8.0), 26.8 non-GP visits (SD = 23.4) and 6.0 outpatient attendances (SD = 7.9) within a one-year follow-up. About 24.7% patients had at least one elective admission, 24.2% had one or more emergency admissions, and 42.3% had one or more A&E attendance within the follow-up. After accounting for a number of demographic and health factors, we found a linear (or proximately linear) association between patient activation and the number of GP visits, emergency admissions and A&E attendance, but a non-linear relationship between patient activation and the number of non-GP visits, the number of outpatient attendance and elective inpatient admission. Conclusions: This study has provided strong empirical evidence from England linking patient activation with healthcare service utilisation. It suggests the value of supporting patient activation as a potential pathway to ease the burden of healthcare system. date: 2021-11-04 date_type: published publisher: Springer Science and Business Media LLC official_url: https://doi.org/10.1186/s12913-021-07115-7 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1898204 doi: 10.1186/s12913-021-07115-7 lyricists_name: Bu, Feifei lyricists_name: Fancourt, Daisy lyricists_id: FBUXX37 lyricists_id: DFANC73 actors_name: Bu, Feifei actors_id: FBUXX37 actors_role: owner full_text_status: public publication: BMC Health Services Research volume: 21 article_number: 1196 issn: 1472-6963 citation: Bu, F; Fancourt, D; (2021) How is patient activation related to healthcare service utilisation? Evidence from electronic patient records in England. BMC Health Services Research , 21 , Article 1196. 10.1186/s12913-021-07115-7 <https://doi.org/10.1186/s12913-021-07115-7>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10137929/1/8dde18b0-8f16-42a4-a00e-8df0f5179325.pdf