Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
Scand J Gastroenterol. 2022 Sep;57(9):1030-1035. doi: 10.1080/00365521.2022.2064724. Epub 2022 Apr 29.
Patient engagement, adaptation and self-management play a critical role in improving Health Related Quality of Life (HRQOL) and reducing health care utilization in chronic disorders. There is no data on the level of patient engagement in patients with cyclic vomiting syndrome (CVS); we thus sought to determine their level of engagement and its association with clinical covariates.
The Patient Activation Measure (PAM-13), a validated tool that measures the degree of patient engagement in their health was administered prospectively to patients with CVS. Data on demographics, health care utilization, and HRQOL (using the NIH PROMIS 10) were obtained. Patients were stratified into low engagement (PAM 1 & 2) and high engagement (PAM 3 & 4). The Fisher's exact test and Wilcoxon rank-sum tests were used to identifying significant differences between the groups.
Of 96 patients, 45% of patients had low levels of patient engagement. On multivariate analysis, low patient engagement was significantly associated with an increased number of CVS hospitalizations in the past year (aOR 1.26 [1.07, 1.54] = .010), lower mental HRQOL scores (aOR 0.88 [0.78, 0.97] = .022), current tobacco use (aOR 4.85 [1.24, 22.74] = .031), and patients who were newly established in a specialized CVS clinic (aOR 44.40 [5.38, 70.02] = .002).
Almost half of CVS patients demonstrate poor patient engagement, which is associated with poor outcomes. Identifying these patients and treatment in a specialized CVS center can potentially improve HRQOL, reduce health care utilization and improve overall healthcare outcomes.
患者参与、适应和自我管理在改善健康相关生活质量（HRQOL）和减少慢性病医疗保健利用方面起着至关重要的作用。目前尚无关于周期性呕吐综合征（CVS）患者参与度水平的数据；因此，我们旨在确定他们的参与度水平及其与临床协变量的关系。
前瞻性地向 CVS 患者发放经过验证的患者激活量表（PAM-13），该量表用于衡量患者在其健康方面的参与程度。收集人口统计学、医疗保健利用和 HRQOL（使用 NIH PROMIS 10）的数据。患者被分层为低参与度（PAM 1 和 2）和高参与度（PAM 3 和 4）。使用 Fisher 确切检验和 Wilcoxon 秩和检验来确定组间的显著差异。
在 96 名患者中，45%的患者表现出较低的患者参与度。在多变量分析中，低患者参与度与过去一年中 CVS 住院次数增加显著相关（优势比 1.26 [1.07, 1.54]，P=0.010），与较低的心理 HRQOL 评分显著相关（优势比 0.88 [0.78, 0.97]，P=0.022），与当前吸烟显著相关（优势比 4.85 [1.24, 22.74]，P=0.031），与新进入专门 CVS 诊所的患者显著相关（优势比 44.40 [5.38, 70.02]，P=0.002）。
近一半的 CVS 患者表现出较差的患者参与度，这与较差的结果相关。在专门的 CVS 中心识别这些患者并进行治疗可能会提高 HRQOL、减少医疗保健利用并改善整体医疗保健结果。
