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Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom

BACKGROUND: 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 activatio...

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Autores principales: Blakemore, Amy, Hann, Mark, Howells, Kelly, Panagioti, Maria, Sidaway, Mark, Reeves, David, Bower, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069882/
https://www.ncbi.nlm.nih.gov/pubmed/27756341
http://dx.doi.org/10.1186/s12913-016-1843-2
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author Blakemore, Amy
Hann, Mark
Howells, Kelly
Panagioti, Maria
Sidaway, Mark
Reeves, David
Bower, Peter
author_facet Blakemore, Amy
Hann, Mark
Howells, Kelly
Panagioti, Maria
Sidaway, Mark
Reeves, David
Bower, Peter
author_sort Blakemore, Amy
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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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spelling pubmed-50698822016-10-24 Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom Blakemore, Amy Hann, Mark Howells, Kelly Panagioti, Maria Sidaway, Mark Reeves, David Bower, Peter BMC Health Serv Res Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. BioMed Central 2016-10-18 /pmc/articles/PMC5069882/ /pubmed/27756341 http://dx.doi.org/10.1186/s12913-016-1843-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.
spellingShingle Research Article
Blakemore, Amy
Hann, Mark
Howells, Kelly
Panagioti, Maria
Sidaway, Mark
Reeves, David
Bower, Peter
Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title_full Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title_fullStr Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title_full_unstemmed Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title_short Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom
title_sort patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the united kingdom
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069882/
https://www.ncbi.nlm.nih.gov/pubmed/27756341
http://dx.doi.org/10.1186/s12913-016-1843-2
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