粪便潜血试验结果呈阳性后，患者激活措施是否与结肠镜检查的依从性相关？

Is the patient activation measure associated with adherence to colonoscopy after a positive fecal occult blood test result?

作者信息

Azulay Revital, Valinsky Liora, Hershkowitz Fabienne, Magnezi Racheli

机构信息

Department of Management, MHA Program, Bar Ilan University, Ramat Gan, Israel.

Central Laboratory, Meuhedet Health Care, 5 Pesach lev, Lod, Israel.

出版信息

Isr J Health Policy Res. 2018 Dec 21;7(1):74. doi: 10.1186/s13584-018-0270-8.

DOI:10.1186/s13584-018-0270-8

PMID:30577883

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6303990/

Abstract

BACKGROUND

Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide, but these can be reduced significantly with population screening using annual fecal occult blood tests (FOBT)A positive FOBT requires timely follow-up with colonoscopy to maximize screening benefits.. Several barriers to follow-up have been identified, with patient health behaviors and choices comprising a significant part of these. The Patient Activation Measure (PAM) assesses knowledge, skills, beliefs, and confidence in managing health. Increased patient activation is related to positive health outcomes. The aim of this study is to examine the association between patient empowerment, as reflected in the PAM, and follow-up colonoscopy within 90 days of a positive FOBT result.

METHODS

This case-control study included 429 patients with a positive FOBT, 174 who had a colonoscopy within 90 days, and 255 who did not.. Participants completed a PAM telephone questionnaire (Cronbach's α = 0.785). We used both univariate and multivariate analyses to examine the effect of the PAM score as on the likelihood of undergoing colonoscopy, after adjusting for the independent variables.

RESULTS

In this study we did not find a significant association between PAM and adherence to colonoscopy, using both univariate and multivariate analyses (p = .334 and p = .697, whether PAM was defined as a continuous or as categorical, respectively).

CONCLUSIONS

This study was the first to examine the association between patient empowerment, as reflected in the patient activation measure, and adherence to colonoscopy after a positive FOBT. The findings did not support such an association. Further examination is required to clarify the relation between patient empowerment and activation and personal healthcare in general, and in the Israeli population in particular. Future policy should include specific, technical interventions to improve FOBT follow-up among all groups, until the patient-related barriers are better understood.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02534142 https://clinicaltrials.gov/ct2/show/NCT02534142.

摘要

背景

结直肠癌（CRC）是全球发病和死亡的主要原因之一，但通过每年进行粪便潜血试验（FOBT）进行人群筛查可显著降低发病率和死亡率。FOBT结果呈阳性需要及时进行结肠镜检查以最大化筛查效益。已确定了一些随访障碍，其中患者的健康行为和选择占了很大一部分。患者激活度量表（PAM）评估管理健康方面的知识、技能、信念和信心。患者激活度的提高与积极的健康结果相关。本研究的目的是探讨PAM所反映的患者赋权与FOBT结果呈阳性后90天内进行结肠镜检查随访之间的关联。

方法

这项病例对照研究纳入了429例FOBT结果呈阳性的患者，其中174例在90天内进行了结肠镜检查，255例未进行。参与者完成了一份PAM电话调查问卷（Cronbach's α = 0.785）。在对自变量进行调整后，我们使用单变量和多变量分析来检验PAM评分对接受结肠镜检查可能性的影响。

结果

在本研究中，无论是单变量分析还是多变量分析，我们均未发现PAM与结肠镜检查依从性之间存在显著关联（无论PAM被定义为连续变量还是分类变量，p分别为0.334和0.697）。

结论

本研究首次探讨了患者激活度量表所反映的患者赋权与FOBT结果呈阳性后结肠镜检查依从性之间的关联。研究结果不支持这种关联。需要进一步研究以阐明患者赋权与激活以及一般个人医疗保健之间的关系，特别是在以色列人群中。未来的政策应包括具体的技术干预措施，以改善所有群体的FOBT随访情况，直到更好地理解与患者相关的障碍。