Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom.
Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom.
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DOI：
10.1186/s12913-016-1843-2
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发表时间：
2016-10-18
影响因子：
2.8
通讯作者：
Bower P
中科院分区：
文献类型：
--
作者：
Blakemore A;Hann M;Howells K;Panagioti M;Sidaway M;Reeves D;Bower P
患者激活被定义为患者在管理其健康方面的知识、技能和信心。更高水平的患者激活与更好的自我管理，更好的健康结果和更低的医疗成本相关。了解患者激活的驱动因素可以更好地定制患者支持和干预。关于患有长期疾病的英国患者的患者激活数据很少。采用前瞻性队列设计。研究人员向英国索尔福德的12,989名65岁以上的患者邮寄了问卷，这些患者至少有一种长期疾病。他们完成了患者激活措施和自我报告措施：抑郁症，健康素养，社会支持，健康相关的生活质量和多重抑郁症的影响。我们报告了基线激活和随时间变化的描述性数据，并使用多变量回归模型与基线时患者激活和6个月内激活变化的预测因子的相关性。该队列包括4377名（33.6%）老年人，其中4225名在6个月时邮寄了进一步的问卷; 3390名（80.2%）返回了完整的问卷。基线时，15%的患者自我报告PAM水平为1级，16%为2级，45%为3级，25%为4级。在所有患者中，抑郁症与患者激活的相关性最强。其他重要因素包括：年龄较大，退休，健康素养差，健康相关的生活质量和社会支持。自我报告的合并症总数和合并症的感知影响对于患有一种以上长期疾病的患者也很重要。患者激活评分随着时间的推移而合理地持续（基线和6个月之间的r = 0.43），尽管近一半的患者在这段时间内改变了激活的“水平”。几个变量预测的变化激活超过6个月。这是英国首次对患者激活进行大规模评估。我们的数据可能有助于识别需要患者激活支持的患者，并允许定制干预措施（如健康指导），以更好地支持患有抑郁症状，社会支持差和健康素养受损的长期疾病的老年患者。对纵向研究的进一步分析将是必要的，以更好地理解患者激活和抑郁等变量之间的因果关系。
Patient Activation is defined as the knowledge, skill, and confidence a patient has in managing their health. Higher levels of patient activation are associated with better self-management, better health outcomes, and lower healthcare costs. Understanding the drivers of patient activation can allow better tailoring of patient support and interventions. There are few data on patient activation in UK patients with long-term conditions. A prospective cohort design was used. Questionnaires were mailed to 12,989 patients over the age of 65 years with at least one long-term condition in Salford, UK. They completed the Patient Activation Measure and self-report measures of: depression, health literacy, social support, health-related quality of life, and impact of multimorbidity. We report descriptive data on baseline activation and change over time, and use multivariate regression to model associations with patient activation at baseline and predictors of change in Activation over 6 months. The cohort included 4377 (33.6 %) older people, of whom 4225 were mailed a further questionnaire at 6 months; 3390 returned it complete (80.2 %). At baseline, 15 % self-reported PAM level 1, 16 % level 2, 45 % level 3, and 25 % level 4. Across all patients, depression had the strongest association with patient activation. Other important factors were: older age, being retired, poor health literacy, health-related quality of life, and social support. Total number of self-reported comorbidities and the perceived impact of comorbidities were also important for patients with more than one long-term condition. Patient activation scores were reasonably enduring over time (r = 0.43 between baseline and at six months), although nearly half changed ‘levels’ of activation over that time. Few variables predicted change in activation over 6 months. This is the first large scale assessment of patient activation in the UK. Our data may be useful in identifying patients who need support with patient activation, and allow interventions (such as health coaching) to be tailored to better support older patients with long-term conditions who have symptoms of depression, poor social support and impaired health literacy. Further analyses of longitudinal studies will be necessary to better understand the causal relationships between patient activation and variables such as depression.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
影响因子：
2.9
作者：
Friis, Karina;Lasgaard, Mathias;Maindal, Helle T.
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通讯作者：
Brooks, R
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作者：
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