School of Population Health, Level 1 Public Health Building, University of Queensland, Herston, 4006, Queensland, Australia.
School of Population Health, Level 1 Public Health Building, University of Queensland, Herston, 4006, Queensland, Australia.
Diabetes Res Clin Pract. 2011 Aug;93(2):260-267. doi: 10.1016/j.diabres.2011.05.031. Epub 2011 Jun 17.
To assess the relationship between patient activation for self-management and admissions to hospital or attendances at emergency departments among people with diabetes, after controlling for other known associations.
Patients were randomly selected from Australia's National Diabetes Services Scheme and invited to participate in the Living with Diabetes Study, which is a longitudinal survey providing a comprehensive examination of health care utilisation, well-being and disease progression. Data was collected for 3951 participants.
Outcome events were defined as 1 or more hospitalization and 1 or more visits to an emergency department in the preceding 12 months. Logistic regression analyses showed six variables remained significantly associated with both outcomes: age, income, disease duration and severity, current depression and PAM stage. Patients at PAM stage 1 were 1.4 times more likely to be hospitalised (p=0.023) and 1.3 times more likely to have visited emergency (p=0.049) compared to those at stage 4.
Low levels of activation are associated with higher utilisation of hospital resources even after controlling for relevant factors such as disease severity and co-morbid depression. Most will be gained by moving patients from PAM stage 1 to a higher level of activation.
在控制其他已知关联因素的情况下，评估糖尿病患者自我管理的患者激活与住院或急诊就诊之间的关系。
从澳大利亚国家糖尿病服务计划中随机选择患者，并邀请他们参加“糖尿病生活研究”，这是一项纵向调查，全面检查了医疗保健的利用、幸福感和疾病进展情况。为 3951 名参与者收集了数据。
结果事件被定义为在过去 12 个月内有 1 次或多次住院和 1 次或多次急诊就诊。逻辑回归分析显示，6 个变量与这两种结果仍然显著相关：年龄、收入、疾病持续时间和严重程度、当前抑郁和 PAM 阶段。与 PAM 阶段 4 的患者相比，PAM 阶段 1 的患者住院的可能性高 1.4 倍（p=0.023），急诊就诊的可能性高 1.3 倍（p=0.049）。
即使在控制了疾病严重程度和合并抑郁等相关因素后，低水平的激活与更高的医院资源利用率相关。通过将患者从 PAM 阶段 1 提升到更高的激活水平，将获得最大收益。
