To identify patterns and predictors of 1-year change in patient activation in chronically ill older adults.
Prospective cohort study.
Integrated healthcare delivery system.
Members of an integrated delivery system from 2007 to 2009 in western Washington state aged 65 and older with diabetes mellitus or heart disease; participants responded to baseline and 1-year follow-up mailed surveys about their health and health care (N = 2,341).
Patient activation was measured using the 13-item Patient Activation Measure (PAM) at baseline and follow-up. Automated diagnoses and procedure data were extracted from databases. Multinomial logistic regression, stratified according to baseline activation stage, was used to estimate the odds ratios for increasing or decreasing activation stage associated with participant characteristics and serious adverse health events.
Fifty-two percent of participants changed activation stage between baseline and follow-up. Of people who changed stage, 54% increased, and 46% decreased. Older age and worse baseline self-reported health were independent predictors of activation change in multivariate models. Changes in health status or serious adverse health events such as the occurrence of hospitalizations, new major diagnoses, or procedures were not related to changes in activation in this age group.
Patient activation, as measured using the PAM, changes over time in elderly adults with chronic diseases. Clinicians and researchers who use the PAM for patient care or as an outcome measure in research studies should be aware of its fluctuation over time in chronically ill older persons.
[Show abstract][Hide abstract] ABSTRACT: "Patient activation" describes the extent to which individuals manage their own healthcare. This study evaluated the association of patient activation, depressive symptoms and quality of life in a primary care setting.
278 patients who visited two primary care clinics were interviewed in the waiting room before their appointment or by telephone. Study participants completed the Patient Activation Measure (PAM), Patient Health Questionnaire-9 (PHQ-9) and Short Form-12 Health Survey (SF-12). Physicians assessed each participant's depression status immediately after the visit.
PAM scores correlated negatively with PHQ-9 (r=-0.35, p<0.0001) and positively with total SF-12 score (r=0.39, p<0.0001). Increased participant involvement by one-level increments on the PAM was predicted by their being in the 55 to 74-year age group and higher total SF-12 quartiles. Almost half of those scoring ≥10 on PHQ-9 were not considered depressed by their physician (false negatives, i.e. "hidden depression").
In primary care settings, PAM is easily administered and useful for general patients and for those with depressive symptoms.
Assessing patient activation will enable caregivers to monitor levels of self-care (activation) and potential adherence to health behavior recommendations. PHQ-9 screening could increase awareness of "hidden depression" in the primary care setting.
[Show abstract][Hide abstract] ABSTRACT: Background: We describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly-eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake. Methods: We identified a cohort of 81,223 men and women who were members of Group Health and turned 50 years old from 1996-2010. We ascertained receipt of colorectal cancer screening within five years. Time to screening was estimated by year of cohort entry using cumulative incidence curves and Cox proportional hazards models estimated patient characteristics associated with screening uptake. Results: Stool-based screening tests were the most common, 72% of first screening tests. The proportion of individuals initiating colorectal cancer screening via colonoscopy increased from 8% in 1996-98 to 33% in 2008-10. Patient factors associated with increased colorectal cancer screening were: turning 50 more recently (2008-10) (p-trend<0.0001) or Asian race (HR=1.14, 95% CI 1.10-1.19). Patient factors associated with decreased screening were: being a woman (HR=0.70, 95% CI 0.68-0.72), Native American (HR=0.68, 95% CI 0.60-0.78) or Pacific Islander race (HR=0.82, 95% CI 0.72-0.95), and having prevalent diabetes (HR=0.78, 95% CI 0.75-0.82) and higher body mass index (p-trend<0.0001). Conclusions: Patient characteristics associated with initiation of colorectal cancer screening in a newly-eligible population are similar to characteristics associated with overall screening participation in all age-eligible adults. Our results identify patient populations to target in outreach programs. Impact: Disparities in receipt of colorectal cancer screening are evident from onset of an age-eligible cohort, identifying key groups for future interventions for screening.
[Show abstract][Hide abstract] ABSTRACT: Patient activation questions from a major national Medicare survey are used to highlight characteristics of Medicare beneficiaries with low activation. We demonstrate that Medicare Current Beneficiary Survey (MCBS) data is an untapped resource for further research on patient activation within Medicare beneficiaries and programs.
Data are from the 2012 MCBS Access to Care file and include 10,650 beneficiaries.
Patient Activation levels were derived by taking the weighted average responses to the Patient Activation Supplement. Cut points for high, moderate, and low activation were assigned at +/- ½ standard deviation of the mean. Data were analyzed using SAS survey procedures. Within group comparisons were tested using chi-square tests with post hoc pairwise comparisons. Logistic regression identified predictors of low patient engagement.
In a multiple logistic regression, beneficiary characteristics associated with low activation included Hispanic origin, being widowed or never married, select age groups, male gender, fair or poor health, difficulty with an IADL or ADLs, and having no usual source of care, with failure to complete high school as the strongest predictor (OR=2.22, p<.001). Utilization and costs were also examined in descriptive analyses.
Overall, findings on the characteristics of low activation patients in the Medicare population resemble previous research. In a regression analysis, less education and no usual source of care are the strongest predictors of low activation levels in Medicare beneficiaries. The MCBS Patient Activation Supplement is a rich resource for examining patient activation in the Medicare population, and can be used for a wide range of analyses.
Medicare and Medicaid Research Review 11/2014; 4(4). DOI:10.5600/mmrr.004.04.b02
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