apricare (Adult Attachment in Primary Care) - Adult attachment and self-management in patients with multimorbidity in primary care

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Self-management is an essential element of evidence-based treatment in patients with chronic diseases in primary care, which is usually considered universally. The primary objective of our apricare study (Adult Attachment in Primary Care) is to analyse self-management depending on adult attachment of patients with multimorbidity in primary care. In this mono-center study with prospective longitudinal design 219 primary care patients with multiple chronic diseases (type II diabetes, hypertension and at least one other chronic disease) between 50-85 years of age from 8 general practices were examined after the recruitment and 12 months later. Attachment was measured by questionnaire and interviews. The primary outcome was self-management skills (FERUS, subscales motivation for change, coping, self-efficacy, self-verbalisation, hope, social support), the secondary outcome were drug-related compliance and quality of life. Number, severity of the disease and socio-demographic variables were considered as covariates. It was also examined if physician-patient relationship can mediate the relationship between adult attachment and self-management. The overall model showed significant correlations for the subscale anxiety (Pillai's trace criterion (fear) = 0,13; F (6, 209) = 4,53, p <0,001 and for the subscale avoidance with the self-management skills (Pillai's trace (avoidance) = 0,14; F (6, 209) = 4,91, p <=0,001). Attachment-related anxiety was significantly negatively associated with self-efficacy, coping, and hope, but significantly positively associated with motivation to change. Avoidance was significantly negatively associated with social support. In the continuation of the study behavioral aspects of self-management (such as blood glucose measurements, diet, compliance with medical contacts), and health-related risk behaviors (such as nicotine and alcohol consumption, obesity, physical inactivity) will be analysed as a function of attachment-related characteristics. In addition, physiological parameters such as blood pressure, long-term glucose levels (HbA1c), BMI and blood lipids of patients will be measured.The results are the basis for the development of individualized training in patients with chronic conditions.