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

自我管理是初级保健中慢性疾病患者循证治疗的基本要素，这通常被认为是普遍的。我们的APICARE研究(初级保健中的成人依恋)的主要目标是分析初级保健中多病患者的自我管理依赖于成人依恋。在这项前瞻性纵向设计的单中心研究中，招募后和12个月后对来自8个全科医生的219名年龄在50-85岁之间的患有多种慢性病(II型糖尿病、高血压和至少一种其他慢性病)的初级保健患者进行了检查。依恋采用问卷调查和访谈的方式进行测量。主要结果是自我管理技能(FERUS、子量表改变动机、应对、自我效能、自我言语、希望、社会支持)，次要结果是与药物相关的依从性和生活质量。数量、疾病严重程度和社会人口学变量被视为协变量。研究还考察了医患关系是否能在成人依恋和自我管理之间起到中介作用。Pillai‘s追踪标准(恐惧)=0，13；F(6,209)=4，53，p&t；0,001；回避与自我管理技能呈显著正相关(P<0.05，P<0.01)。依恋相关焦虑与自我效能感、应对方式、希望显著负相关，与改变动机显著正相关。回避与社会支持呈显著负相关。在这项研究的继续中，将分析自我管理的行为方面(如血糖测量、饮食、对医疗接触的遵守情况)以及与健康有关的危险行为(如尼古丁和酒精消费、肥胖、缺乏身体活动)，作为依恋相关特征的函数。此外，还将测量患者的血压、长期血糖水平(HbA1c)、体重指数和血脂等生理参数，为开展慢性病患者的个性化训练奠定基础。

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.