Karl Florian M, Holle Rolf, Schwettmann Lars, Peters Annette, Laxy Michael
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany,
German Center for Diabetes Research (DZD), Neuherberg, Germany,
Patient Prefer Adherence. 2018 Sep 26;12:1937-1945. doi: 10.2147/PPA.S175045. eCollection 2018.
Patient self-management is crucial to prevent complications and mortality in type 2 diabetes. From an economic perspective, time preference predicts short-sighted decision making and thus might help to explain non-adherence to self-anagement recommendations. However, recent studies on this association have shown mixed results.
In this study, we tested whether the combination of time preference and outcome expectancy can improve the predictions of self-management behavior.
Data from 665 patients with type 2 diabetes were obtained from the cross-sectional KORA (Cooperative Health Research in the Region of Augsburg) GEFU 4 study. Time preference and outcome expectancy were measured by one question each, which were answered on a 4-point Likert scale. Their association with six self-managing behaviors was tested in logistic and linear regression analyses. Likewise, we examined the association between self-management and the interaction of outcome expectancy and time preference.
A high time preference was associated with a significantly lower sum of self-management behaviors (β=-0.29, 95% CI [-0.54, -0.04]). Higher outcome expectancy was associated with a higher self-management score (β=0.21, 95% CI [-0.03, 0.45]). The interaction model showed that low time preference was only associated with better self-management when combined with a high outcome expectancy (β=0.05, 95% CI [-0.28, 0.39] vs β=0.27, 95% CI [-0.09, 0.63]).
Time preference and outcome expectancy are interrelated predictors of patient self-management and could be used to identify and to intervene on patients with a potentially poor self-management.
患者自我管理对于预防2型糖尿病的并发症和死亡率至关重要。从经济角度来看，时间偏好预示着短视的决策，因此可能有助于解释对自我管理建议的不依从性。然而，近期关于这种关联的研究结果不一。
在本研究中，我们测试了时间偏好和结果期望的组合是否能改善对自我管理行为的预测。
来自665名2型糖尿病患者的数据取自横断面的奥格斯堡地区合作健康研究（KORA）GEFU 4研究。时间偏好和结果期望分别通过一个问题进行测量，答案采用4点李克特量表。在逻辑回归和线性回归分析中测试了它们与六种自我管理行为的关联。同样，我们研究了自我管理与结果期望和时间偏好的相互作用之间的关联。
高时间偏好与自我管理行为总和显著降低相关（β=-0.29，95%可信区间[-0.54，-0.04]）。更高的结果期望与更高的自我管理得分相关（β=0.21，95%可信区间[-0.03，0.45]）。相互作用模型显示，只有在与高结果期望相结合时，低时间偏好才与更好的自我管理相关（β=0.05，95%可信区间[-0.28，0.39] 对比β=0.27，95%可信区间[-0.09，0.63]）。
时间偏好和结果期望是患者自我管理的相互关联的预测因素，可用于识别并干预自我管理可能较差的患者。
