Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
J Gen Intern Med. 2013 May;28(5):668-74. doi: 10.1007/s11606-012-2307-y.
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.
To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients.
Cross-sectional survey.
433 patients receiving care in four HIV clinics.
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.
Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence.
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 count > 200 cells/mL(3) (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.
Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.
患者激活量表（PAM）评估了慢性病管理中的几个重要概念，包括积极健康行为的自我效能。在感染 HIV 的人群中，更好的药物管理自我效能与提高抗逆转录病毒药物（ARV）的依从性相关，这对于控制症状和减缓疾病进展至关重要。
确定 1）与患者激活相关的特征，2）患者激活与 HIV 感染患者结局之间的关联。
横断面调查。
433 名在四家 HIV 诊所接受护理的患者。
在患者接受 HIV 诊所就诊后，由访视员对其进行面对面访谈。调查数据通过病历摘录进行补充，以获取最近的 CD4 计数、HIV 病毒载量和抗逆转录病毒药物。
使用 13 项 PAM（可能范围 0-100）测量患者激活。结局包括 CD4 细胞计数＞200 个/μL(3)、HIV-1 RNA＜400 拷贝/mL（病毒抑制）和患者报告的依从性。
总体而言，患者激活程度较高（平均 PAM=72.3[SD 16.5，范围 34.7-100]）。与具有高中学历的患者相比，未接受过高中教育的患者激活程度较低（68.0 对 74.0，p＜0.001），抑郁程度较高（最低为 77.6 分，中间为 70.2 分，最高为 68.1 分，p＜0.001）。患者激活与年龄、种族、性别、酒精使用问题、非法药物使用或社会地位无关。在多变量模型中，PAM 每增加 5 分，CD4 细胞计数＞200 个/μL(3)的可能性就会增加（优势比 1.10[95%置信区间 1.01,1.21]），依从性（优势比 1.18[95%置信区间 1.09,1.29]）和病毒抑制（优势比 1.08[95%置信区间 1.00,1.17]）的可能性也会增加。PAM 与病毒抑制之间的关联是通过依从性介导的。
较高的患者激活与更有利的 HIV 结局相关。应开发并测试改善患者激活的干预措施，以提高 HIV 结局。
