Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

Abstract

ObjectivesThis study aimed to explore the association between patient activation and patients’ experience of care among an elderly multimorbid population in Germany.DesignCross-sectional study.SettingPrimary care practices in two German settings.Participants346 patients with 3 or more chronic conditions aged 65 years and over from 36 primary care practices.Outcome measuresPatient activation was measured with the patient activation measure (PAM). To assess patient experiences with primary care, a set of questions concerning domains of primary care were included. Multilevel regression analyses were performed to examine which domains of care were associated with patient activation.ResultsOut of 1243 invited patients, a total of 346 took part in the study (participation rate 27.8 %). Mean PAM score was 76.1. Across all patients, 3.8% achieved PAM level 1, 7.5% level 2, 27.2% level 3% and 60.7% level 4. PAM scores suggest a highly activated patient group. In the regression analysis, three out ten domains of patients’ experiences showed an association with patient activation. The domains ‘being involved in decision as much as desired’ (B=−8.56, p=0.012) and ‘receiving a self-management plan’ (B=6.51, p=0.051) were associated with higher patient activation scores. Patients with an up-to-date medication plan had lower patient activation scores (B=−12.01, p=0.041).ConclusionSpecific domains of primary care were found to be associated with patient activation. To enhance patient activation, primary care physicians may increase involvement of patients in decisions. Future research should examine the causality of these associations.Trial registration numberDRKS00015718.

Walking in their shoes: How primary‐care experiences of adults aged 50+ reveal the benefits of e‐learning intervention for general practitioners

“…Our earlier studies showed that e‐learning for GPs focused on activating communication with mature patients might be feasible and effective, even though observed changes in activation were subtle, and broader in patients' ratings (Rzadkiewicz et al, 2017) than in doctors' self‐ratings (Wlodarczyk et al, 2019). Activating communication skills are seen here as the GP's ability to interact with patients in a way that promotes their involvement and an active approach to treatment and health However, the present study focuses more on patient direct post‐visit experience rather than on activation itself, yet assuming the former could strongly shape the latter (Breckner et al, 2022).…”

Family nurses’ perceptions of proactive management of high-risk patients and identification of pertinent training needs

“…Chronic diseases and multiple chronic diseases or multimorbidity are the most prevalent public health challenges worldwide [1,2]. Non-communicable diseases (NCD) such as diabetes, cardiovascular and chronic respiratory diseases cause high mortality globally (74%) [2] and high expenditure on healthcare [3,4]. In Estonia in 2021, 92% of deaths resulted from NCDs, which is similar to the other Baltic countries, with the statistics for Latvia and Lithuania being 92% and 91%, respectively.…”

“…In this study, high-risk patients are defined as patients with multiple chronic conditions or a certain number of co-morbidities caused by health behavior, or who take different medications at the same time and are overusing the health care system. Proactive management of high-risk patients includes key elements such as self-efficacy and active participation in their own care process and decisionmaking [4,6]. Patient activation or proactive management could be defined as the patient's own knowledge, skills, self-confidence, and behavior to manage and improve their own health [7].…”