Assi Lama, Kozhaya Karim, Swenor Bonnielin K, Reed Nicholas S
Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Ophthalmic Epidemiol. 2023 Apr;30(2):159-165. doi: 10.1080/09286586.2022.2078495. Epub 2022 May 20.
Low patient activation is associated with poor patient outcomes. People with vision impairment may have low patient activation as a result of communication and access barriers. We examined the association of patient activation with vision impairment.
Cross-sectional study using the 2016 Medicare Current Beneficiary Survey. Older Medicare beneficiaries, without dementia, who completed the topical patient activation questionnaire were included. The primary exposure was self-reported vision impairment (no vision impairment, a little vision impairment, a lot of vision impairment), and the secondary exposure was dual sensory impairment (no sensory impairment, vision impairment only, hearing impairment only, dual sensory impairment). Patient activation scores were categorized as low, moderate, or high based on their distribution around the mean. Multivariable-adjusted ordinal regression models examined the association of patient activation with vision impairment, and then with dual sensory impairment.
In total, 6,683 participants were included. Those with a little vision impairment had 20% lower odds of higher patient activation (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.71-0.90), and those with a lot of vision impairment had 26% lower odds of higher patient activation (OR = 0.74, 95% CI = 0.55-0.98). In the second model, having vision or hearing impairment only was associated with lower odds of higher activation than having no sensory impairment. Having dual sensory impairment was associated with even lower odds of higher activation.
Older Medicare beneficiaries with sensory impairment may be a group to target to improve patient activation levels, which could potentially improve health outcomes and health care utilization patterns in this population.
患者激活水平低与不良的患者预后相关。视力障碍患者可能由于沟通和就医障碍而导致患者激活水平低。我们研究了患者激活与视力障碍之间的关联。
采用2016年医疗保险当前受益人调查进行横断面研究。纳入了完成主题患者激活问卷的无痴呆的老年医疗保险受益人。主要暴露因素是自我报告的视力障碍（无视力障碍、轻度视力障碍、重度视力障碍），次要暴露因素是双重感官障碍（无感官障碍、仅视力障碍、仅听力障碍、双重感官障碍）。根据患者激活分数围绕均值的分布情况，将其分为低、中、高三个类别。多变量调整后的有序回归模型检验了患者激活与视力障碍之间的关联，然后检验了与双重感官障碍之间的关联。
总共纳入了6683名参与者。轻度视力障碍者的患者激活水平较高的几率低20%（优势比[OR]=0.80，95%置信区间[CI]=0.71-0.90），重度视力障碍者的患者激活水平较高的几率低26%（OR=0.74，95%CI=0.55-0.98）。在第二个模型中，仅患有视力或听力障碍者与激活水平较高的几率低于无感官障碍者相关。患有双重感官障碍者与激活水平较高的几率更低相关。
患有感官障碍的老年医疗保险受益人可能是提高患者激活水平的目标群体，这可能会改善该人群的健康结局和医疗保健利用模式。
