Bayliss Elizabeth A, Ellis Jennifer L, Steiner John F
Kaiser Permanente Clinical Research Unit, Denver, Colo 80237-8066, USA.
Ann Fam Med. 2007 Sep-Oct;5(5):395-402. doi: 10.1370/afm.722.
Persons with multiple chronic diseases must integrate self-management tasks for potentially interacting conditions to attain desired clinical outcomes. Our goal was to identify barriers to self-management that were associated with lower perceived health status and, secondarily, with lower reported physical functioning for a population of seniors with multimorbidities.
We conducted a cross-sectional telephone survey of 352 health maintenance organization members aged 65 years or older with, at a minimum, coexisting diagnoses of diabetes, depression, and osteoarthritis. Validated questions were based on previous qualitative interviews that had elicited potential barriers to the self-management process for persons with multimorbidities. We analyzed associations between morbidity burden, potential barriers to self-management, and the 2 outcomes using multivariate linear regression modeling.
Our response rate was 47%. Sixty-six percent of respondents were female; 55% were aged 65 to 74 years, and 45% were aged 75 years or older. Fifty percent reported fair or poor health. On average they had 8.7 chronic diseases. In multivariate analysis, higher level of morbidity, lower level of physical functioning, less knowledge about medical conditions, less social activity, persistent depressive symptoms, greater financial constraints, and male sex were associated with lower perceived health status. Potential barriers to self-management significantly associated with lower levels of physical functioning were higher level of morbidity, greater financial constraints, greater number of compound effects of conditions, persistent depressive symptoms, higher level of patient-clinician communication, and lower income.
In addition to morbidity burden, specific psychosocial factors are independently associated with lower reported health status and lower reported physical functioning in seniors with multimorbidities. Many factors are amenable to intervention to improve health outcomes.
患有多种慢性病的患者必须整合针对潜在相互作用病症的自我管理任务，以实现期望的临床结果。我们的目标是确定与较低的健康状况感知相关的自我管理障碍，其次，确定与患有多种疾病的老年人群中较低的身体功能报告相关的自我管理障碍。
我们对352名65岁及以上的健康维护组织成员进行了横断面电话调查，这些成员至少同时患有糖尿病、抑郁症和骨关节炎。经过验证的问题基于先前的定性访谈，这些访谈引出了患有多种疾病的人群在自我管理过程中的潜在障碍。我们使用多元线性回归模型分析了发病负担、自我管理的潜在障碍与这两个结果之间的关联。
我们的回应率为47%。66%的受访者为女性；55%的受访者年龄在65至74岁之间，45%的受访者年龄在75岁及以上。50%的受访者报告健康状况一般或较差。他们平均患有8.7种慢性病。在多变量分析中，较高的发病水平、较低的身体功能水平、对医疗状况的了解较少、社交活动较少、持续的抑郁症状、较大的经济限制以及男性性别与较低的健康状况感知相关。与较低身体功能水平显著相关的自我管理潜在障碍包括较高的发病水平、较大的经济限制、较多的病症复合效应、持续的抑郁症状、较高的医患沟通水平以及较低的收入。
除了发病负担外，特定的社会心理因素与患有多种疾病的老年人较低的健康状况报告和较低的身体功能报告独立相关。许多因素都适合进行干预以改善健康结果。
