PATIENTS Kanu C 1 Brown C 1 Barner J 1 Chapman C 2 Walker H 2 1 Health Outcomes amp Pharmacy Practice Division College of Pharmacy The University of Texas ID: 810877
Download The PPT/PDF document "PATIENT ACTIVATION IN INFLAMMATORY BOWEL..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
PATIENT ACTIVATION IN INFLAMMATORY BOWEL DISEASE PATIENTSKanu C1, Brown C1 , Barner J1 , Chapman C2 , Walker H2 1Health Outcomes & Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA,2Gastroenterology Associates, Baton Rouge, Louisiana, USA.
Background
Materials & Methods
Objective
Inflammatory bowel disease (IBD) is
a chronic illness characterized
by relapsing and remitting inflammation of the intestinal
tissue. This inflammation gives
rise to a myriad of physical, psychological and social disabilities in patients with this condition.1Patient activation refers to the confidence, skill and knowledge that a patient possesses which determines the level of participation in managing his or her health and healthcare. Patients with a high activation level partner with their healthcare providers to manage their disease condition which results in better health outcomes.2,3The knowledge of each patient’s activation stage at the point of care can enable healthcare providers to interact with IBD patients at their level of understanding and provide them with stage-appropriate information to promote participation in their healthcare management.
To describe the demographic characteristics of IBD patients in different patient activation stages.
Convenience sampling was used to select adult IBD patients from medical records who had scheduled office visits from April to August 2016. Inclusion criteria:Adult IBD patients (> 18 years) who were patients of the study clinic sitePatients with moderate to severe Crohn’s disease/ulcerative colitis on immunomodulators (methotrexate or azathioprine) or biologic therapy (adalimumab, infliximab, certolizumab, or vedolizumab) Patients who had office visits scheduled from April to August 2016Patients who expressed willingness and gave their consent to participateExclusion criteria:Children (17 years or younger) with IBDPatients who did not have moderate to severe Crohn’s disease or ulcerative colitis; andPatients with recent surgical intervention or hospitalization for a non-IBD related disease. Patients who gave their consent to participate in the study were sent a mail paper survey or an electronic survey via the UT Austin Qualtrics portal The survey consisted of the patient activation (PAM-13) instrument and demographic/clinical questions. Responses to the PAM-13 items were converted to a PAM score using the PAM-13 score spreadsheet.Patient activation scores were used to group patients into one of the four progressive patient activation stages (Figure 1) Demographics were analyzed descriptively and compared per activation stage.
Results
Table 1: Patient Activation Mean Scores by Demographics
Discussion
Limitations
Self-reported data
Low rate of
survey
completion
Selection
bias arising from convenience sampling
Limited generalizability of findings because only one study site was used
Conclusions
The IBD patients in this study generally had high activation levels which remained unchanged across demographic and clinical characteristics
.
Patient activation could be utilized by healthcare providers to engage in customized information exchange with individual patients. Future studies examining patient activation in IBD patients should focus on more diverse patient populations.
References
Molodecky NA, Kaplan GG. Environmental Risk Factors for Inflammatory Bowel Disease. Gastroenterology & Hepatology. 2010;6(5):339-346. Greene J, Hibbard JH. Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Journal of General Internal Medicine. 2012;27(5):520-526.Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918-1930.
Four Stages of Activation
Believes Active Role ImportantConfidence and Knowledge to Take ActionTaking ActionStaying the Course under Stress
Key: Item calibrations are the calibrated scale value of the item.
Respondent DemographicsMean age - 48 years (±18years) Caucasian - 88% Female - 64%College graduates - 56%Crohn’s disease patients - 59.2%51% had an active inflammation50% had been diagnosed >5 yearsPatient Activation ScoresMajority were highly activated - Mean activation score of 65.0 (±10.3) 8%, 14%, 46%, and 32% in Stages 1, 2, 3, and 4, respectively. Demographic and stage comparisons were not significant.
Figure
2
:
Patient Activation Staging Distribution
Table 2:
Patient
Demographics by PAM Stage
VariablePatient Activation Mean Score (SD)AgeBelow 40 years (n = 20)64.5 (11.0)Above 40 years (n = 30)66.3 (15.9)GenderMale (n = 18)60.4 (9.4) Female (n = 32)68.5 (15.5) RaceCaucasian (n = 44)65.4 (13.9)African American (n = 5)69.5 (17.1) Hispanic (n = 1)55.6 (0.0)EducationLess than high school graduate (n = 2)66.7 (15.6) High school graduate (n = 19)61.5 (15.0) College graduate (n = 28)68.7 (13.2) IBD typeUlcerative colitis(n = 18)65.4 (14.7)Crohn’s disease(n = 29)66.4 (14.3) Other(n = 2)60.5 (10.3)IBD stateActive inflammation (n = 24)65.4 (13.1)IBD in remission (n = 23)65.0 (15.5)Time since diagnosisLess than 1 year (n = 8)66.4 (11.9)1 - 5 years (n = 16)63.9 (11.1)More than 5 years (n =25)66.8 (16.7)
VariablesPAM stageChi square (P value)Stage 1Stage 2Stage 3Stage 4AgeBelow 40 years (n = 20)1 (5.0)4 (20.0)8 (40.0)7 (35.0)1.59 (0.67)Above 40 years (n = 30)3 (10.0)3 (10.0)15 (50.0)9 (30.0)GenderMale (n = 18)2 (11.1)3 (16.7)11 (61.1)2 (11.1)5.71 (0.09)Female (n = 32)2 (6.3)4 (12.5)12 (37.5)14 (43.7)RaceCaucasian (n =44)3 (6.8)7 (15.9)21 (47.7)13 (29.6)2.52 (0.42)Other (n = 6)1 (16.7)0 (0.0)2 (33.4)3 (50.0)EducationLess than college degree (n = 21)3 (14.3)4 (19.0)9 (42.9)5 (23.8)3.91 (0.39)College graduate (n = 28)1 (3.6)3 (10.7)13 (46.4)11 (39.3)IBD typeUlcerative colitis (n = 20)1 (5.0)4 (20.0)9 (45.0)6 (30.0)1.26 (0.78)Crohn’s disease (n = 29)3 (10.3)3 (10.3)13 (44.9)10 (34.5)IBD stateActive inflammation (n = 24)2 (8.4)3 (12.5)11 (45.8)8 (33.3)0.41 (0.94)IBD in remission (n = 23)2 (8.7)4 (17.4)11 (47.8)6 (26.1)Time since diagnosis< 5 years (n = 24)1 (4.1)4 (16.7)10 (41.7)9 (37.5)1.55 (0.67)> 5 years (n = 25)3 (12.0)3 (12.0)12 (48.0)7 (28.0)
The patient activation level of this study population was high. Over 50% of higher level stage 3 and 4 patients were female, Caucasian, college graduates, and over 40 years old. Patients with such high activation levels are already participating in their IBD management to a reasonable extent and are more likely to have positive health outcomes.
Figure 1: Patient Activation Measure with Item Calibrations and the Four Stages Identified