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Erschienen in:

01.05.2013 | Original Research

Patient Activation and Improved Outcomes in HIV-Infected Patients

verfasst von: Rebecca Marshall, MD, MPH, Mary Catherine Beach, MD, MPH, Somnath Saha, MD, MPH, Tomi Mori, PhD, Mark O. Loveless, MD, MHA, Judith H. Hibbard, DrPH, Jonathan A. Cohn, MD, Victoria L. Sharp, MD, P. Todd Korthuis, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2013

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ABSTRACT

BACKGROUND

The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression.

OBJECTIVE

To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients.

DESIGN

Cross-sectional survey.

PARTICIPANTS

433 patients receiving care in four HIV clinics.

METHODS

An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications.

MAIN MEASURES

Patient activation was measured using the 13-item PAM (possible range 0–100). Outcomes included CD4 cell count > 200 cells/mL³, HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence.

KEY RESULTS

Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7–100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL³ (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence.

CONCULSIONS

Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

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Titel: Patient Activation and Improved Outcomes in HIV-Infected Patients
verfasst von: Rebecca Marshall, MD, MPH
Mary Catherine Beach, MD, MPH
Somnath Saha, MD, MPH
Tomi Mori, PhD
Mark O. Loveless, MD, MHA
Judith H. Hibbard, DrPH
Jonathan A. Cohn, MD
Victoria L. Sharp, MD
P. Todd Korthuis, MD, MPH
Publikationsdatum: 01.05.2013
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 5/2013
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-012-2307-y

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ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

METHODS

MAIN MEASURES

KEY RESULTS

CONCULSIONS

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