Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes

Begum, Nelufa; Donald, Maria; Ozolins, Ieva; Dower, Jo

doi:10.1016/j.diabres.2011.05.031

Cited by 98 publications

(94 citation statements)

References 32 publications

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“…In the USA, a national survey conducted in 1999 indicated a prevalence of 26.9% 46 ; in Australia, a longitudinal study among people with DM found a prevalence of 21.6% 47 , results close to those found in our study. 18 .…”

Section: Discussionsupporting

confidence: 80%

“…We verified that only 2% of people with DM were considered adherents, well below the values found in the literature. If the first two levels were grouped (adherence and probable adherence), the prevalence of adherence would be compatible with that described in the literature, but still below what would be considered acceptable 47 . In addition, we found significant regional differences, which should be further studied.…”

Section: Discussionsupporting

confidence: 56%

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Acesso e adesão a medicamentos entre pessoas com diabetes no Brasil: evidências da PNAUM

Meiners

Tavares

Guimarães

et al. 2017

Rev. bras. epidemiol.

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ABSTRACT:Objective: To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs. Methods: Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ 2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%. Results: We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions. Conclusion: Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 56%

Acesso e adesão a medicamentos entre pessoas com diabetes no Brasil: evidências da PNAUM

Meiners

Tavares

Guimarães

et al. 2017

Rev. bras. epidemiol.

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“…It is conceivable then that for a patient without these skills (i.e., low patient activation) an acute event requiring hospitalization could be sufficiently debilitating to undermine the patient's ability to learn and carry out important self-care duties in the postdischarge setting, resulting in an increased risk of an unplanned return to the hospital. While there have been both prospective and cross-sectional studies associating lower activation scores with higher risk of hospitalization, [13][14][15] there have been no studies linking the activation score with readmissions or with 30-day unplanned readmissions. One Australian study did find higher readmission rates among patients categorized as frequent utilizers of hospital services compared with similar patients with chronic disease self-management support, suggesting a role for patient activation in reducing avoidable readmissions.…”

Section: Introductionmentioning

confidence: 99%

Patient Activation and 30-Day Post-Discharge Hospital Utilization

et al. 2013

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BACKGROUND: Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined. METHODS: A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hospital. Data from 695 Englishspeaking general medical inpatient subjects were analyzed. We used an adapted, eight-item version of the validated Patient Activation Measure (PAM). Total scores were categorized, according to standardized methods, as one of four PAM levels of activation: Level 1 (lowest activation) through Level 4 (highest activation). The primary outcome measure was total 30-day post-discharge hospital utilization, defined as total emergency department (ED) visits plus hospital readmissions including observation stays. Poisson regression was used to control for confounding. RESULTS: Of the 695 subjects, 67 (9.6 %) were PAM Level 1, 123 (17.7 %) were Level 2, 193 (27.8 %) were Level 3, and 312 (44.9 %) were Level 4. Compared with highly activated patients (PAM Level 4), a higher rate of 30-day post-discharge hospital utilization was observed for patients at lower levels of activation (PAM Level 1, incident rate ratio [IRR] 1.75, 95 % CI,1.18 to 2.60) and (PAM Level 2, IRR 1.50, 95 % CI 1.06 to 2.13). The rate of returning to the hospital among patients at PAM Level 3 was not statistically different than patients with PAM Level 4 (IRR 1.30, 95 % CI, 0.94 to 1.80). The rate ratio for PAM Level 1 was also higher compared with Level 4 for ED use alone (1.68(1.07 to 2.63)) and for hospital readmissions alone (1.93 [1.22 to 3.06]). CONCLUSION: Hospitalized adult medical patients in an urban academic safety net hospital with lower levels of Patient Activation had a higher rate of post-discharge 30-day hospital utilization.

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“…8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with higher levels of self-management. [37][38][39] Research to date has not examined whether clinicians' behaviors influence patients' level of activation, however.…”

Section: Introductionmentioning

confidence: 99%

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

et al. 2016

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PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation.METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTSClinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation.CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness. 2016;14:148-154. doi:10.1370/afm.1904. Ann Fam Med INTRODUCTIONT hrough policies such as pay for performance and public reporting of clinicians' quality of care, clinicians are increasingly responsible for their patients' care outcomes. [1][2][3][4] Yet, for health outcomes to improve, patients must do their part, following through on treatment regimens and making recommended lifestyle changes.5-7 Given the key role that patients play in determining health outcomes, policy makers have made patient engagement and patient activation a major focus, including embedding approaches for increasing engagement in the Patient Protection and Affordable Care Act. 8,9 Patient activation, which is defined as having the knowledge, confidence, and skills to take care of one's health and health care, has been shown to be associated with a broad range of health-related outcomes, including better self-management and clinical indicators, fewer hospitalizations, and lower health care costs. [10][11][12][13][14][15][16][17][18][19][20] [34][35][36] Also, patients' assessment of clinician support of the chronic care model has been associated with hig...

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Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes

Cited by 98 publications

References 32 publications

Acesso e adesão a medicamentos entre pessoas com diabetes no Brasil: evidências da PNAUM

Acesso e adesão a medicamentos entre pessoas com diabetes no Brasil: evidências da PNAUM

Patient Activation and 30-Day Post-Discharge Hospital Utilization

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

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