Patient activation and improved outcomes in HIV-infected patients

Rebecca Marshall, Mary Catherine Beach, Somnath (Som) Saha, Motomi (Tomi) Mori, Mark O. Loveless, Judith H. Hibbard, Jonathan A. Cohn, Victoria L. Sharp, Philip (Todd) Korthuis

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. Objective: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Design: Cross-sectional survey. Participants: 433 patients receiving care in four HIV clinics. Methods: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Main Measures: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count200 cells/mL3, HIV-1 RNA400 copies/mL (viral suppression), and patientreported adherence. Key Results: Overall, patient activation was high (mean PAM=72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p.001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p.001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count200 cells/mL3 (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Conculsions: Higher patient activation was associated with more favorable HIVoutcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

Original languageEnglish (US)
Pages (from-to)668-674
Number of pages7
JournalJournal of General Internal Medicine
Volume28
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Patient Participation
HIV
Self Efficacy
Interviews
Aptitude
Health Behavior
Street Drugs
CD4 Lymphocyte Count
Ambulatory Care
Viral Load
Medical Records
Disease Progression
HIV-1
Patient Care

Keywords

  • HIV
  • Medication adherence
  • Patient activation
  • Patient outcomes
  • Self-efficacy

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Patient activation and improved outcomes in HIV-infected patients. / Marshall, Rebecca; Beach, Mary Catherine; Saha, Somnath (Som); Mori, Motomi (Tomi); Loveless, Mark O.; Hibbard, Judith H.; Cohn, Jonathan A.; Sharp, Victoria L.; Korthuis, Philip (Todd).

In: Journal of General Internal Medicine, Vol. 28, No. 5, 05.2013, p. 668-674.

Research output: Contribution to journalArticle

Marshall, Rebecca ; Beach, Mary Catherine ; Saha, Somnath (Som) ; Mori, Motomi (Tomi) ; Loveless, Mark O. ; Hibbard, Judith H. ; Cohn, Jonathan A. ; Sharp, Victoria L. ; Korthuis, Philip (Todd). / Patient activation and improved outcomes in HIV-infected patients. In: Journal of General Internal Medicine. 2013 ; Vol. 28, No. 5. pp. 668-674.
@article{6ef21455f358421ea1fa9728cd1fdc15,
title = "Patient activation and improved outcomes in HIV-infected patients",
abstract = "Background: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. Objective: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Design: Cross-sectional survey. Participants: 433 patients receiving care in four HIV clinics. Methods: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Main Measures: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count200 cells/mL3, HIV-1 RNA400 copies/mL (viral suppression), and patientreported adherence. Key Results: Overall, patient activation was high (mean PAM=72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p.001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p.001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count200 cells/mL3 (aOR 1.10 [95 {\%} CI 1.01, 1.21]), adherence (aOR 1.18 [95 {\%} CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 {\%} CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Conculsions: Higher patient activation was associated with more favorable HIVoutcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.",
keywords = "HIV, Medication adherence, Patient activation, Patient outcomes, Self-efficacy",
author = "Rebecca Marshall and Beach, {Mary Catherine} and Saha, {Somnath (Som)} and Mori, {Motomi (Tomi)} and Loveless, {Mark O.} and Hibbard, {Judith H.} and Cohn, {Jonathan A.} and Sharp, {Victoria L.} and Korthuis, {Philip (Todd)}",
year = "2013",
month = "5",
doi = "10.1007/s11606-012-2307-y",
language = "English (US)",
volume = "28",
pages = "668--674",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Patient activation and improved outcomes in HIV-infected patients

AU - Marshall, Rebecca

AU - Beach, Mary Catherine

AU - Saha, Somnath (Som)

AU - Mori, Motomi (Tomi)

AU - Loveless, Mark O.

AU - Hibbard, Judith H.

AU - Cohn, Jonathan A.

AU - Sharp, Victoria L.

AU - Korthuis, Philip (Todd)

PY - 2013/5

Y1 - 2013/5

N2 - Background: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. Objective: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Design: Cross-sectional survey. Participants: 433 patients receiving care in four HIV clinics. Methods: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Main Measures: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count200 cells/mL3, HIV-1 RNA400 copies/mL (viral suppression), and patientreported adherence. Key Results: Overall, patient activation was high (mean PAM=72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p.001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p.001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count200 cells/mL3 (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Conculsions: Higher patient activation was associated with more favorable HIVoutcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

AB - Background: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. Objective: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Design: Cross-sectional survey. Participants: 433 patients receiving care in four HIV clinics. Methods: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Main Measures: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count200 cells/mL3, HIV-1 RNA400 copies/mL (viral suppression), and patientreported adherence. Key Results: Overall, patient activation was high (mean PAM=72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p.001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p.001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count200 cells/mL3 (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Conculsions: Higher patient activation was associated with more favorable HIVoutcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

KW - HIV

KW - Medication adherence

KW - Patient activation

KW - Patient outcomes

KW - Self-efficacy

UR - http://www.scopus.com/inward/record.url?scp=84891435089&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891435089&partnerID=8YFLogxK

U2 - 10.1007/s11606-012-2307-y

DO - 10.1007/s11606-012-2307-y

M3 - Article

C2 - 23288378

AN - SCOPUS:84891435089

VL - 28

SP - 668

EP - 674

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 5

ER -