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Lunardi LE, K Le Leu R, Matricciani LA, Xu Q, Britton A, Jesudason S, Bennett PN. Patient activation in advanced chronic kidney disease: a cross-sectional study. J Nephrol 2024; 37:343-352. [PMID: 38345687 PMCID: PMC11043190 DOI: 10.1007/s40620-023-01847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Patient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes. AIM To examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation. METHODS/DESIGN People with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence. RESULTS Two hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001). CONCLUSION Patient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.
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Affiliation(s)
- Laura E Lunardi
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia.
- Clinical & Health Sciences, University of South Australia, South Australia, Australia.
| | - Richard K Le Leu
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Lisa A Matricciani
- Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, South Australia, Australia
| | - Anne Britton
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, South Australia, Australia
| | - Paul N Bennett
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
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Li WY, Yeh JC, Cheng CC, Huang SH, Yeh HC, Cheng BW, Lin JW, Yang FJ. Digital health interventions to promote healthy lifestyle in hemodialysis patients: an interventional pilot study. Sci Rep 2024; 14:2849. [PMID: 38310128 PMCID: PMC10838291 DOI: 10.1038/s41598-024-53259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
Low physical activity has been associated with poor prognosis in hemodialysis (HD) patients. Interventions to maintain healthy lifestyle in this population are important to reduce mortality. This study aimed to evaluate the effectiveness of digital health interventions (DHIs) for improving the physical activity and health-related quality of life (HRQoL) in HD patients. The 24-week prospective study enrolled 31 clinically stable HD patients. All participants were assigned home exercises and provided with wearable devices. Dietary and exercise information was uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24. HRQoL and nutritional status were evaluated. A total of 25 participants completed the study. After the interventions, the daily step count increased 1658 steps. The 10-time-repeated sit-to-stand test reduced by 4.4 s, the sit-to-stand transfers in 60 s increased 12 repetitions, the distance of six-minute walk test (6MWT) increased by 55.4 m. The mental health components and burden of kidney disease of the Kidney Disease Quality of Life survey, and subjective global assessment (SGA) scores improved. By Spearman correlation, the monthly step count correlated positively with 6MWT and SGA. DHIs that combined wearable devices, a health management platform, and social media could strengthen physical activity and improve the HRQoL and nutrition of maintenance HD patients. The results outline a new model to promote healthy lifestyle behaviors in HD patients.
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Affiliation(s)
- Wen-Yi Li
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiang-Chou Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Cheng-Chih Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Su-Hua Huang
- Department of Dietetics, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Hui-Chin Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
- Department of Applied Foreign Languages, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Jou-Wei Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Feng-Jung Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliu, Yunlin County, 640, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Soejima T, Kitao M. Adaptation and measurement invariance of the 13-item version of Patient Activation Measure across Japanese young adult cancer survivors during and after treatment: A cross-sectional observational study. PLoS One 2023; 18:e0291821. [PMID: 37725596 PMCID: PMC10508623 DOI: 10.1371/journal.pone.0291821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
The 13-item version of the Patient Activation Measure (PAM-13) is a frequently used measure that gauges the level of self-management in an individual. However, its applicability across Japanese young adult (YA) cancer survivors during and after their treatment remains unclear. This study confirmed the psychometric properties and measurement invariance of the Japanese version of PAM-13 across them during and after treatment. We used cross-sectional observational data collected through an online survey from 500 survivors in January 2022. We determined feasibility, internal consistency, concurrent validity against physical fatigue and depression, and known-groups validity regarding educational level. Structural validity was also found using Rasch analysis for survivors both during and after treatment. Furthermore, measurement invariance of the PAM-13 was examined using multiple-group structural equation modeling. Rasch fit statistics were acceptable for the unidimensional structure of PAM-13. It was found to be internally consistent for survivors during (McDonald's omega: 0.88, item-total correlations: 0.48-0.62) and after treatment (McDonald's omega: 0.90, item-total correlations: 0.32-0.72). The PAM-13 was concurrently valid with physical fatigue (Pearson's product-moment correlation coefficients: -0.25 and -0.18 for survivors during and after treatment, respectively) and depression (Pearson's product-moment correlation coefficients: -0.20 and -0.19 for survivors during and after treatment, respectively). Known-groups validity showed that survivors after treatment with a higher educational level reported a higher patient activation score than those with a lower educational level (p = 0.001); however, there was no difference due to the education level between survivors during treatment. The configural and metric invariance of the PAM-13 were confirmed, but scalar invariance was rejected. It was found that the PAM-13 is applicable for Japanese YA cancer survivors during and after treatment. However, given the lack of scalar invariance in the PAM-13, the scores of particular items between YA cancer survivors during and after treatment should be interpreted with caution.
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Affiliation(s)
- Takafumi Soejima
- Department of Child Health Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Mari Kitao
- Department of Child Health Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
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Mirmazhari R, Ghafourifard M, Sheikhalipour Z. Relationship between patient activation and self-efficacy among patients undergoing hemodialysis: a cross-sectional study. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient activation in chronic kidney disease (CKD) is increasingly being prioritized and considered a quality metric in CKD. Given the importance of patients’ activation in improving the quality of chronic disease care, this study aimed to assess patients’ activation levels and its relationship with self-efficacy among patients undergoing hemodialysis.
Methods
In this cross-sectional study, a total of 180 patients undergoing maintenance hemodialysis were selected by random sampling from the largest hemodialysis center (dialysis center of Emam Reza hospital, Tabriz) in Iran. Data were collected by demographics, patient activation measure, and chronic kidney disease self-efficacy (CKD-SE) scale from March to May 2021. Collected data were analyzed using SPSS software (ver. 26) using ANOVA, t-test, Pearson correlation coefficient, and multiple regression tests.
Results
The majority of the participants (35%) were at level 1 of activation and only 28.9% of the individuals were at level 4. According to the results, the mean score of self-efficacy in patients undergoing hemodialysis (in a possible range of 0–10) was 5.50 ± 1.45. Multiple regression analysis showed that factors including self-efficacy, educational level, and marital status were significant predictors of change in patient activation (R2 = 0.85, adjusted R2 = 0.66, p < 0.001). The results showed that self-efficacy was the main predictor of patient activation (β = 0.49, p < 0.001).
Conclusion
According to the result, improving the patients' self-efficacy could improve the patient's activation. Moreover, patients with lower educational level reported the lower activation score; therefore, health care providers should improve the knowledge of patients with lower educational level, encourage them to be more active in their health care, and help them in providing more tailored strategies to improve the quality of care more efficiently. Furthermore, Measuring patients' activation level at admission to the dialysis unit is recommended for all patients undergoing hemodialysis.
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Lightfoot CJ, Nair D, Bennett PN, Smith AC, Griffin AD, Warren M, Wilkinson TJ. Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease? KIDNEY AND DIALYSIS 2022; 2:91-105. [PMID: 37101653 PMCID: PMC10127536 DOI: 10.3390/kidneydial2010012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one's own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual's level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.
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Affiliation(s)
- Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester,Leicester LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester LE5 4PW, UK
- Correspondence: ; Tel.: +44-116-252-3211
| | - Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA
| | - Paul N. Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester,Leicester LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Anthony D. Griffin
- Leicester Kidney Lifestyle Team, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Madeleine Warren
- Leicester Kidney Lifestyle Team, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Thomas J. Wilkinson
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
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6
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Magadi W, Lightfoot CJ, Memory KE, Santhakumaran S, van der Veer SN, Thomas N, Gair R, Smith AC. Patient activation and its association with symptom burden and quality of life across the spectrum of chronic kidney disease stages in England. BMC Nephrol 2022; 23:45. [PMID: 35081904 PMCID: PMC8793272 DOI: 10.1186/s12882-022-02679-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022] Open
Abstract
Background The knowledge, skills, and confidence to manage one’s own health is termed patient activation and can be assessed using the Patient Activation Measure (PAM). This measure is increasingly recommended for use in chronic kidney disease (CKD), but there is a need to better understand patient activation within this population. This work aimed to explore the association of PAM with patient-reported outcomes, namely symptom burden and health-related quality of life (HRQoL), to understand the relationship between patient activation and outcomes which are of importance to people with CKD. Methods Non-dialysis, dialysis, and kidney transplant patients from 14 renal units across England completed a survey comprising questionnaires assessing patient activation, symptom burden, and HRQoL. Latent class analysis (LCA) was used to determine HRQoL and symptom burden subgroups in the data. Multinomial logistic regression analyses were performed to investigate the associations between patient activation and symptom burden and HRQoL classes separately, adjusting for age, gender, ethnicity, deprivation and treatment modality. Results Three thousand thirteen participants (mean age 61.5 years, 61.8% males, and 47% haemodialysis) were included in the analysis. Patient activation was strongly associated with both the HRQoL and symptom burden classes identified, with highly activated patients more likely to report higher HRQoL (P = < 0.0001; OR 29.2, 95% CI 19.5–43.9) and fewer symptoms (P = < 0.0001; OR 25.9, 95% CI 16.8–40.2). Conclusion Lower activation levels are associated with a higher symptom burden and reduced HRQoL across the trajectory of CKD stages and treatment modalities. Therefore, targeted and holistic self-management support focussing on improving activation may have the potential to improve aspects of health experience which are valued by individuals living with kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02679-w.
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Affiliation(s)
- Winnie Magadi
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK.
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katherine E Memory
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Shalini Santhakumaran
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nicola Thomas
- School of Health and Social Care, London South Bank University, London, UK
| | - Rachel Gair
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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7
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Hussein WF, Bennett PN, Sun SJ, Reiterman M, Watson E, Farwell IM, Schiller B. Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study. J Patient Exp 2022; 9:23743735221112220. [PMID: 35924026 PMCID: PMC9340399 DOI: 10.1177/23743735221112220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient activation is the product of knowledge, skills, and confidence that
enables a person to manage their own healthcare. It is associated with healthy
behaviors and improved patient outcomes. We surveyed prevalent hemodialysis (HD)
patients at 10 centers using the Patient Activation Measure 13-item instrument
(PAM-13). Activation was reported as scores (0-100) and corresponding levels
(1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92%
response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was
41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with
14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis,
older age and having diabetes were associated with lower activation, whereas
higher educational levels and female gender were associated with higher scores.
Significant variation in activation was observed among participants from
different centers even after adjustment for other variables. In conclusion, low
activation is common among prevalent HD patients.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | | | | | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
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8
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Theys S, Malfait S, Eeckloo K, Verhaeghe S, Beeckman D, Van Hecke A. Patient empowerment in Flemish hospital wards: a cross-sectional study. Acta Clin Belg 2021; 76:453-461. [PMID: 32397919 DOI: 10.1080/17843286.2020.1762350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Measuring empowerment of patients on Flemish hospital wards by the short form of the Patient Activation Measure (PAM-13) and exploring the association between patient empowerment and patient-centred care, health literacy, patient- and context-related characteristics.Methods: Secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders between February and June 2016. Patients needed to be admitted for a least 1 day, aged 18 years or over, and mentally competent with adequate ability to speak and read the Dutch language. Independent t-tests, one-way ANOVA and multivariable regression analysis were performed.Results: Mean empowerment was 58. Of the 670 patients, 22.7% tended to be unprepared to play an active role in their health care, 22.2% were struggling to manage own health, 39.4% reported to take action to maintain and improve own health, and 15.7% reported having confidence to perform adequate behaviours in most circumstances. Multivariable analysis showed that patients living together with family, a partner or a friend (p = 0.018), with higher health literacy (p < 0.001), and with higher perceptions of individuality in patients' care (p < 0.001) had higher empowerment scores.Conclusion: The multivariable analysis found three variables associated with patient empowerment and provided empirical evidence for the interrelatedness between patient-centred care and patient empowerment. Future research should use a clear framework to make sure that all relevant determinants of patient empowerment are included. Interventions to improve patient empowerment should incorporate patient characteristics and elements of both health literacy and patient-centred care.
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Affiliation(s)
- Sofie Theys
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | | | - Kristof Eeckloo
- Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Skin Integrity Research Group (SKINT), Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Southern Denmark
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
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9
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Skovlund PC, Vind Thaysen H, Schmidt H, Alsner J, Hjollund NH, Lomborg K, Nielsen BK. Effect of patient-reported outcomes as a dialogue-based tool in cancer consultations on patient self-management and health-related quality of life: a clinical, controlled trial. Acta Oncol 2021; 60:1668-1677. [PMID: 34403293 DOI: 10.1080/0284186x.2021.1962972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND With increased survival among patients with metastatic melanoma and limited time with health care providers, patients are expected to assume a more active role in managing their treatment and care. Activated patients have the knowledge, skills, and confidence to make effective solutions to self-manage health. The use of patient-reported outcomes (PRO) could have the potential to enhance patient activation. However, PRO-based interventions that facilitate an activation in patients with metastatic melanoma are lacking and warranted. MATERIAL AND METHODS In this prospective non-randomized controlled, clinical trial, patients with metastatic melanoma were assigned to either the intervention (systematic feedback and discussion of PRO during consultation) given at one hospital or the control group (treatment as usual) if they received treatment from two other hospitals in Denmark. The primary outcome was the patient activation measure (PAM), which reflects self-management. Secondary outcomes were health-related quality of life (HRQoL), self-efficacy, and Patient-Physician interaction. Outcomes were measured at baseline, and after 3, 6, and 12 months. The analysis of the effect from baseline to 12 months employed mixed-effects modeling. RESULTS Between 2017 and 2019, patients were allocated to either the intervention group (n = 137) or the control group (n = 142). We found no significant difference in the course of patient activation between the two groups over time. The course of HRQoL was statistically significantly improved by the intervention compared to the control group. Especially, females in the intervention group performed better than males. The other secondary outcomes were not improved by the intervention. CONCLUSION The intervention did not improve knowledge, skills, and confidence for self-management for patients with metastatic melanoma. Neither did it improve coping self-efficacy nor perceived efficacy in Patient-Physician interaction. However, the results suggest that the intervention can have a significant impact on HRQoL and in particular social and emotional well-being among the females.
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Affiliation(s)
- Pernille Christiansen Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jan Alsner
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex – Center for Patient-reported Outcomes, Hospital Unit West Jutland, Herning, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Aarhus N, Denmark
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Enggarwati P, Dahlia D, Maria R. Social support as a mediator between depressive symptoms and self-care activities in adults patient with type 2 diabetes mellitus. J Public Health Res 2021; 11. [PMID: 35255669 PMCID: PMC8958446 DOI: 10.4081/jphr.2021.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with type 2 DM are at risk of experiencing depression, which in turn can affect their self-care activities. Recent evidence has shown that social support is beneficial in reducing the risk of depression and positively affecting increases in self-care activities. However, the role of social support in the relationship between depressive symptoms and self-care activities has not been studied. This study aims to determine the mediating effects of social support on the relationship between depressive symptoms and self-care activities of people with type 2 DM. DESIGN AND METHODS A cross-sectional consecutive sampling approach was used with 94 respondents with type 2 diabetes in East Jakarta, Indonesia, who were undergoing diabetes treatments during May-June 2020. The instruments used were the Centre for Epidemiologic Studies-Depression Scale (CES-D), Summary of Diabetes Self Care Activities (SDSCA), and Duke-UNC Functional Social Support Questionnaire (DUFSSQ). All three questionnaires have been tested for validity and reliability. Data analysis was carried out using multiple linear regression, path analysis, and the Sobel test. RESULTS The results of multiple linear regression analysis on the variables age, sex, education level, socioeconomic status, duration of type 2 DM, and complications of type 2 DM showed that only complications of type 2 diabetes affected self-care activities (p = 0,000; R2 = 0.515). The results of the path analysis and Sobel test showed that social support significantly mediated the effects of the relationship between depressive symptoms and self-care activities (z = -0,162 > table 1.96; direct effect = -0,499; indirect effect = -0,0789; total effect = 40, 3%). CONCLUSIONS Screening for depressive symptoms and interventions involving social support are strongly suggested for patients with type 2 DM who are suspected of showing a decline in self-care activities.
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Affiliation(s)
| | | | - Riri Maria
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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11
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Leone DRR, Pereira GA, Silva ACDP, Aguiar ASD. Fatores associados à ativação de pacientes em hemodiálise. AVANCES EN ENFERMERÍA 2021. [DOI: 10.15446/av.enferm.v40n1.90046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objetivo: mensurar a ativação de pacientes em hemodiálise e determinar os fatores associados à ativação dessa população.
Materiais e método: estudo exploratório, de caráter descritivo e corte transversal com 162 pacientes em tratamento hemodialítico no interior de Minas Gerais, Brasil. Os dados foram coletados de janeiro a abril de 2019, com instrumentos para avaliação sociodemográfica, socioeconômica e clínica e da escala Patient Activation Measure de 13 itens. A análise de dados foi realizada por estatística descritiva e regressão de Poisson com variância robusta.
Resultados: a medida de ativação dos pacientes em hemodiálise variou de 39,4 a 90,7 pontos, em que a média é 60,85 + 15,57 pontos e a mediana 53,2 (IC: 58,4-63,3) pontos. Dos participantes, 52,5 % (n = 85) apresentavam baixa ativação, sendo que o menor quantitativo de pessoas (18,5 %, n = 30) se encontrava no nível 3. Foi associado à maior prevalência de alta ativação o fato de apresentar o nível superior de ensino e não necessitar de cuidador.
Conclusões: embora as variáveis associadas à alta ativação não sejam modificadas pelos profissionais de saúde, conhecê-las permite inferir qual o perfil de pacientes em hemodiálise que necessitam de intervenções direcionadas ao aumento dos níveis de ativação.
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Golubinski V, Wild EM. Factors associated with patient activation in a socially deprived population: Evidence from Germany. PATIENT EDUCATION AND COUNSELING 2021; 104:2791-2802. [PMID: 33863586 DOI: 10.1016/j.pec.2021.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population. METHODS We conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis. RESULTS Our results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation. CONCLUSIONS Age, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation. PRACTICE IMPLICATIONS Our results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.
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Affiliation(s)
- Veronika Golubinski
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Eva-Maria Wild
- Department of Health Care Management, Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
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Shukla AM, Bozorgmehri S, Ruchi R, Mohandas R, Hale-Gallardo JL, Ozrazgat-Baslanti T, Orozco T, Segal MS, Jia H. Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies. Perit Dial Int 2021; 41:453-462. [PMID: 33258420 PMCID: PMC10038064 DOI: 10.1177/0896860820975586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined. METHODS Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD. RESULTS Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7-2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4-1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5-1.9)). CONCLUSIONS Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.
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Affiliation(s)
- Ashutosh M Shukla
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Shahab Bozorgmehri
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Rupam Ruchi
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Rajesh Mohandas
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Jennifer L Hale-Gallardo
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Tezcan Ozrazgat-Baslanti
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Tatiana Orozco
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
| | - Mark S Segal
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
- Division of Nephrology, Hypertension, and Transplantation, 3463University of Florida, Gainesville, FL, USA
| | - Huanguang Jia
- Division of Nephrology, 158428North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA
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Hussein WF, Bennett PN, Abra G, Watson E, Schiller B. Integrating Patient Activation Into Dialysis Care. Am J Kidney Dis 2021; 79:105-112. [PMID: 34461165 DOI: 10.1053/j.ajkd.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022]
Abstract
Patient activation, the measure of patients' readiness and willingness to manage their own health care, is low among people receiving in-center hemodialysis, which is exacerbated because such centers are commonly set up for patients to passively receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the health care system. To improve patient activation, we need to embrace a patient-first approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the health care team as well as changes in care delivery models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need health care policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move toward a more active role for patients in their care.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
| | - Paul N Bennett
- Satellite Healthcare, San Jose, California; Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Graham Abra
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Factors of Anti-Vascular Endothelial Growth Factor Therapy Withdrawal in Patients with Neovascular Age-Related Macular Degeneration: Implications for Improving Patient Adherence. J Clin Med 2021; 10:jcm10143106. [PMID: 34300272 PMCID: PMC8306388 DOI: 10.3390/jcm10143106] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 11/17/2022] Open
Abstract
We investigated the factors associated with the discontinuation of anti-vascular endothelial growth factor (VEGF) therapies in patients with neovascular age-related macular degeneration (AMD). Japanese patients with AMD aged ≥50 years, reporting at least one prior injection of an anti-VEGF drug, completed an online survey covering reasons for discontinuation or dissatisfaction with therapy, quality of life (EQ-5D-5L) and patient activation (PAM-13). The respondents were divided into two cohorts: Cohort 1-patients who discontinued anti-VEGF therapy (n = 207); Cohort 2-patients continuing anti-VEGF therapy (n = 65). The most common reason for discontinuing therapy was the "doctor's decision" in 89.4% (Cohort 1-1). In the other 22 (10.6%) patients in Cohort 1 (Cohort 1-2), reasons included "no deterioration in vision", "financial burden" and "ineffective treatment". Patients in Cohort 2 were dissatisfied with "long waiting times" (77%), "financial burden" and "ineffective treatment". Pain/discomfort posed the greatest impact on quality of life. Only 5% of patients in Cohorts 1-1 and 2 and none in Cohort 1-2 were considered advocates for their own health. In conclusion, most patients who discontinued anti-VEGF therapy did so at their doctor's decision. Addressing the reasons associated with discontinuation or dissatisfaction with anti-VEGF therapies might help improve their continuation.
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Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial. PLoS One 2021; 16:e0251652. [PMID: 34197486 PMCID: PMC8248609 DOI: 10.1371/journal.pone.0251652] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). Evidence supporting targeted interventions is needed. This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. Methods Participants were recruited from nephrology outpatient clinics to this two-arm parallel group mixed-methods pilot RCT. Inclusion criteria were: ≥65 years old; CKD G3b-5; and Clinical Frailty Scale score ≥4. Participants categorised as pre-frail or frail using the Frailty Phenotype were randomised to a 12-week progressive multi-component home-based exercise programme or usual care. Primary outcome measures included eligibility, recruitment, adherence, outcome measure completion and participant attrition rate. Semi-structured interviews were conducted with participants to explore trial and intervention acceptability. Results Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% CI 29, 36) eligible. Thirty-five (16%; 95% CI 12, 22) participants were recruited. Six were categorised as robust and withdrawn prior to randomisation. Fifteen participants were randomised to exercise and 14 to usual care. Eleven (73%; 95% CI 45, 91) participants completed ≥2 exercise sessions/week. Retained participants completed all outcome measures (n = 21; 100%; 95% CI 81, 100). Eight (28%; 95% CI 13, 47) participants were withdrawn. Fifteen participated in interviews. Decision to participate/withdraw was influenced by perceived risk of exercise worsening symptoms. Participant perceived benefits included improved fitness, balance, strength, well-being, energy levels and confidence. Conclusions This pilot RCT demonstrates that progression to definitive RCT is possible provided recruitment and retention challenges are addressed. It has also provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and CKD. Trial registration ISRCTN87708989; https://clinicaltrials.gov/.
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Wilkinson TJ, Memory K, Lightfoot CJ, Palmer J, Smith AC. Determinants of patient activation and its association with cardiovascular disease risk in chronic kidney disease: A cross-sectional study. Health Expect 2021; 24:843-852. [PMID: 33835670 PMCID: PMC8235879 DOI: 10.1111/hex.13225] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background Patient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes. Design Cross‐sectional study. Setting and participants Patients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK. Outcome measures Patient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia. Results 743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P = .004), greater number of comorbidities (P = .026) and lower haemoglobin (P = .025). Patients with low activation had a 17% greater number of CVD risk factors (P < .001). Risk factors in those with low activation were being older (P < .001) and having diabetes (P < .001). Conclusion This study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation. Patient or Public Contribution Patients were involved in the design of main study.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katherine Memory
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jared Palmer
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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Raimundo-Leone DR, De Paula-Silva AC, Silva-de Aguiar A. Ativação do paciente com diagnóstico de doença renal crônica: uma revisão integrativa. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Estabelecer a medida de ativação de pacientes com doença renal crônica e seus fatores associados. Metodologia: Revisão integrativa de literatura realizada nas seguintes bases de dados: Pubmed, Lilacs, Scielo, Scopus, Science Direct e Insignia Health. Foram utilizados os descritores: Patient Activation, Nephrology, Kidney e Renal Insufficiency, Chronic e seus correspondentes em português e espanhol e os operadores booleanos AND e OR. Não foi utilizado filtro de data para as buscas. Nove manuscritos compuseram a amostra final desta revisão. Resultados: A média do escore de ativação variou entre 51±10 e 65,02±16 pontos, com o predomínio de pessoas com alta ativação (níveis 3 e 4). A ativação do paciente foi associada a múltiplas variáveis, entre elas a idade, condição socioeconômica, escolaridade e carga de sintomas. Conclusões: Conhecer o nível de ativação dos pacientes e os fatores associados a ele direciona a atuação do profissional de saúde para obtenção e/ou manutenção da alta ativação.
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Affiliation(s)
| | | | - Aline Silva-de Aguiar
- Universidade do Estado do Rio de Janeiro. Residência de Enfermagem em Nefrologia. Rio de Janeiro. Brasil
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Patient Activation and its Predictors in Hospitalized Older Adults in Singapore. Geriatr Nurs 2021; 42:336-343. [PMID: 33556900 DOI: 10.1016/j.gerinurse.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AIMS To explore patient activation and its predictors in hospitalized older adults in Singapore. METHODS Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. RESULTS 300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (β=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care. CONCLUSION Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.
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20
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Leone DRR, Pereira GA, Silva ACDP, Aguiar ASD. Nível de ativação e qualidade de vida relacionada à saúde de pessoas em hemodiálise. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo associar o nível de ativação com a qualidade de vida relacionada à saúde de pessoas que realizam o tratamento hemodialítico. Método estudo quantitativo, transversal e correlacional com 162 pessoas em tratamento hemodialítico. Os dados foram coletados por meio da aplicação de questionários para a caracterização sociodemográfica, socioeconômica e clínica do Kidney Disease Quality of Life Short Form e da escala Patient Activation Measure. Os dados secundários foram coletados por meio do prontuário médico. Para a análise dos dados, utilizaram-se a estatística descritiva e a regressão logística. Resultados a ativação do paciente em hemodiálise associou-se positivamente com os domínios sintomas, funcionamento físico, saúde geral, bem-estar emocional, energia/fadiga e o componente mental da qualidade de vida relacionada à saúde. Conclusão e implicação para a prática como a ativação apresenta relação com a qualidade de vida relacionada à saúde, na prática assistencial, essa métrica deve ser considerada ao implementar medidas que visem a aumentar a qualidade de vida relacionada à saúde das pessoas em hemodiálise.
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Kurtz C, Geron R, Shadmi E. Interest and perceived capability of self-care in haemodialysis units. J Clin Nurs 2020; 30:645-654. [PMID: 33289199 DOI: 10.1111/jocn.15584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/10/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
AIMS To (a) assess patients' interest and perceived capability of participating in haemodialysis; (b) assess nurses' perceptions of patients' interest and perceived capability of participating in haemodialysis; and (c) examine associations between patient characteristics and interest and perceived capability of performing haemodialysis self-care. DESIGN Cross-sectional, questionnaire-based study. METHODS Data were collected from dialysis patients and their nurses between October 2018-May 2019. Patients' interest and perceived capability of participation were assessed by a 10-item Likert-type scale developed and tested for this study, with responses ranging from 1 (not interested/no perceived capability) to 5 (already doing task independently). Multivariate linear regression was used to assess the relationship between patient characteristics, including age, sex, education level and severity of illness to ratings of activation level and haemodialysis self-care scale scores. The STROBE checklist was used as a guideline for this study. RESULTS Ninety-one patients and 31 nurses participated. Overall, patients expressed interest (2.43 ± 0.93) and perceived themselves capable (2.34 ± 0.9) of participating in various haemodialysis-related tasks. Nurses assessed lower interest (2.19 ± 0.77) than patients, but similar average capability (2.31 ± 0.8). Both greater interest and perceived capability were correlated with more years of education and higher patient activation; additionally, interest was associated with disease severity and perceived capability was associated with age. CONCLUSION Haemodialysis patients are interested and perceive themselves capable of participating in the tasks involved in dialysis care. Nurses underestimate patient interest in participation. RELEVANCE TO CLINICAL PRACTICE Self-care behaviours among haemodialysis patients are important, as they may affect quality of life and survival. Determining interest and perceived capability of participation is a first step towards evaluating the feasibility of self-care in a supervised haemodialysis setting.
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Affiliation(s)
- Chava Kurtz
- Galilee Medical Center, Nahariya, Israel.,The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | | | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Blumrosen C, Desta R, Cavanaugh KL, Laferriere HE, Bruce MA, Norris KC, Griffith DM, Umeukeje EM. Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review. Patient Prefer Adherence 2020; 14:1435-1444. [PMID: 32884245 PMCID: PMC7443008 DOI: 10.2147/ppa.s260684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients. METHODS Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review. RESULTS Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance. DISCUSSION/CONCLUSION Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.
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Affiliation(s)
| | | | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather E Laferriere
- Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marino A Bruce
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| | - Derek M Griffith
- Center for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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Nair D, Cavanaugh KL. Measuring Patient Activation as Part of Kidney Disease Policy: Are We There Yet? J Am Soc Nephrol 2020; 31:1435-1443. [PMID: 32527978 DOI: 10.1681/asn.2019121331] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Optimal care occurs when patients possess the skills, knowledge, and confidence needed to effectively manage their health. Promoting such patient activation in kidney disease care is increasingly being prioritized, and patient activation has recently emerged as central to kidney disease legislative policy in the United States. Two options of the Centers for Medicare and Medicaid Services Kidney Care Choices model-the Kidney Care First option and the Comprehensive Kidney Care Contracting option-now include patient activation as a quality metric; both models specifically name the patient activation measure (PAM) as the patient-reported outcome to use when assessing activation in kidney disease. Because nephrology practices participating in these models will receive capitated payments according to changes in patients' PAM scores, it is time to more critically evaluate this measure as it applies to patients with kidney disease. In this review, we raise important issues related to the PAM's applicability to kidney health, review and summarize existing literature that applies this measure to patients with kidney disease, and outline key elements to consider when implementing the PAM into practice and policy. Our aim is to spur further dialogue regarding how to assess and address patient activation in kidney disease to facilitate best practices for supporting patients in the successful management of their kidney health.
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Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee .,Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee.,Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
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Kiberd J, Khan U, Stockman C, Radhakrishnan A, Phillips M, Kiberd BA, West KA, Soroka S, Chan C, Tennankore KK. Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study. Can J Kidney Health Dis 2018; 5:2054358118794415. [PMID: 30210802 PMCID: PMC6130084 DOI: 10.1177/2054358118794415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background Improving a patient's experience with their care through an online interface for communication (an eHealth patient portal) has been shown to be beneficial in some studies of chronic disease populations. However, little is known about the effectiveness of an eHealth portal for delivery of care to home dialysis patients. Objectives Primary: To determine whether an eHealth portal is effective at improving a patient's experience with their home dialysis care. Secondary: (1) To determine whether an eHealth portal improves health-related quality of life for home dialysis patients, (2) to assess patient satisfaction with an eHealth portal and perceived impact on aspects of their home dialysis therapy and health, (3) to determine the acceptability of the eHealth portal software, and (4) to determine the change in telephone usage for communication after patient adoption of an eHealth portal. Design Single-arm pilot trial with recruitment over a 4-month period. Setting The multidisciplinary home dialysis clinic in Halifax Nova Scotia Canada. Patients Adults (>18 years) receiving either home hemodialysis or peritoneal dialysis. Measurements Consumer quality index (CQI), health-related quality of life using the EuroQol Five Dimensions Questionnaire (EQ-5D), acceptability of the eHealth portal software (using the Acceptability E-scale), and satisfaction/perceived impact (using a modified questionnaire). Methods A web-based application (McKesson, Canada, RelayHealth®) allowed patients and health care workers to communicate through a secure, password-protected online portal that permitted visualization of the messaging history by patient and provider. Patients and the home dialysis health care team had the ability to send messages related to patient care at any time including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations, or questions about care. Patient experience with home dialysis care using the CQI, health-related quality of life using the EQ-5D, acceptability of the eHealth portal software, and satisfaction/perceived impact were assessed at baseline, 6, and 12 months of follow-up (where applicable). Total minutes of telephone communication was assessed prior to and after adoption of the portal. Results Of the 41 patients who consented to join the portal, 27 (66%) created an online account. At baseline, patients had a positive experience for the care and communication provided by their nephrologist (CQI: 3.63, 95% confidence interval [CI]: 3.50-3.76) and this did not change significantly over the study period. Similar results were observed for the care provided by other nephrology health care team members. Health-related quality of life using the EQ-5D score was 0.80 (interquartile range [IQR]: 0.71-0.83) at baseline and this also did not significantly change over the study period. Patients were satisfied with the eHealth portal (mean Likert scale score of 6.5 ± 0.6 in overall satisfaction, scale ranging from 1 completely dissatisfied to 10 completely satisfied), but only a minority (N = 12) completed a satisfaction questionnaire. Median monthly phone usage decreased from 12.5 to 10 minutes (P = .02) after adoption of the portal. Limitations The study is limited by the small sample size, high rate of patient dropout, and limited response rate. Conclusions In this study of home dialysis patients, we identified that an eHealth communication did not lead to significant improvements in patient experience with home dialysis care. Trial Registration ClinicalTrials.gov number NCT02128347.
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Affiliation(s)
| | - Usman Khan
- Nova Scotia Health Authority, Halifax, Canada
| | | | | | | | - Bryce A Kiberd
- Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Kenneth A West
- Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Steven Soroka
- Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | | | - Karthik K Tennankore
- Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
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