Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study

Abstract

ObjectiveTo evaluate the extent of patient activation and factors associated with activation in adults with comorbid diabetes and chronic kidney disease (CKD).DesignA cross-sectional study.SettingRenal/diabetes clinics of four tertiary hospitals across the two largest states of Australia.Study populationAdult patients (over 18 years) with comorbid diabetes and CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2).Main outcome measuresPatients completed the Patient Activation Measure, the Kidney Disease Quality of Life and demographic and clinical data survey from January to December 2014. Factors associated with patient activation were examined using χ2 or t-tests and linear regression.ResultsThree hundred and five patients with median age of 68 (IQR 14.8) years were studied. They were evenly distributed across socioeconomic groups, stage of kidney disease and duration of diabetes but not gender. Approximately 46% reported low activation. In patients with low activation, the symptom/problem list, burden of kidney disease subscale and mental composite subscale scores were all significantly lower (all p<0.05). On multivariable analysis, factors associated with lower activation for all patients were older age, worse self-reported health in the burden of kidney disease subscale and lower self-care scores. Additionally, in men, worse self-reported health in the mental composite subscale was associated with lower activation and in women, worse self-reported health scores in the symptom problem list and greater renal impairment were associated with lower activation.ConclusionFindings from this study suggest that levels of activation are low in patients with diabetes and CKD. Older age and worse self-reported health were associated with lower activation. This data may serve as the basis for the development of interventions needed to enhance activation and outcomes for patients with diabetes and CKD.

Religiosity and Patient Activation Among Hospital Survivors of an Acute Coronary Syndrome

“…33 The mean PAM score in the present study was 59.7 which is consistent with the average activation scores in different patient populations and settings. 21,34 However, more than onehalf of our study participants had low levels of activation, in contrast with studies in patients with chronic conditions such as heart failure 35 and diabetes. 20 The extent of low patient activation in the present study may be explained by the sudden occurrence of their acute illness, not allowing sufficient time for engagement with their healthcare.…”

“…18 In examining the relationship between religiosity and patient activation, we categorized patient activation levels into low (levels 1 and 2) and high (levels 3 and 4), an approach used in prior studies. 20,21…”

Guidelines for review of patients on haemodialysis: Are we meeting patient needs?

“…The literature often describes low patient engagement and patient activation (defined as the willingness of patients to take on the role of managing their own health and health care 22 ) in people with chronic diseases. [22][23][24] People with kidney disease may resist dietary change due to feeling deprived and reduced quality of life with dietary restrictions, previous habits and norms, overwhelming information, not confident in the efficacy of making dietary changes and imposition on social events. 25 Given these motivational barriers, exploring decisional balance with patients, building relationships and high level motivational interviewing skills of clinicians are likely to be important strategies in supporting people with chronic disease to achieve good health outcomes.…”

“…25 Given these motivational barriers, exploring decisional balance with patients, building relationships and high level motivational interviewing skills of clinicians are likely to be important strategies in supporting people with chronic disease to achieve good health outcomes. 25 Additionally, with depression and self-reported poorer mental health also impacting on activation, 22,23 an interdisciplinary approach to care including psychology may be required to address motivational barriers. 26 In the present study, one in five patients felt they saw a dietitian when they did not need it, and 50% reported a preference to see a dietitian when they have a question or concern rather than at predefined intervals.…”

Shared Hemodialysis Care

“…Among kidney patients, those with lower activation levels tend to be older, more likely to be on HD and have higher levels of deprivation (4). Furthermore, levels of activation tend to be low among people who have a combination of diabetes and CKD (5). Patients with diabetes who have lower levels of activation attend more frequently at emergency departments and are more likely to be hospitalized (6).…”