Paukkonen Leila, Oikarinen Anne, Kähkönen Outi, Kaakinen Pirjo
Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland.
Medical Research Centre Oulu Finland.
Health Sci Rep. 2022 Jul 20;5(4):e735. doi: 10.1002/hsr2.735. eCollection 2022 Jul.
Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation - a patient's knowledge, skills, and confidence in managing own health - on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL).
A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, -tests, analysis of variance, linear modeling, the test, and binary regression analysis.
The mean score of patient activation was 56.12 (SD 12.82) on a scale 0-100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people.
Patient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.
多病共存是全球包括芬兰在内的主要公共卫生和医疗保健挑战。由于多病共存需要在日常生活中进行自我管理，患者激活（即患者管理自身健康的知识、技能和信心）对自我管理能力的影响值得研究，尤其是在初级医疗保健环境中。本研究旨在评估多病共存的初级医疗保健患者的患者激活情况，确定与患者激活相关的因素，并确定激活程度低和高的患者在健康和自我管理行为、相关认知以及健康相关生活质量（HRQoL）方面是否存在差异。
对参加芬兰初级医疗保健咨询的多病共存患者进行了横断面调查（2019年11月至2020年5月）。主要结果指标即患者激活情况，使用患者激活量表（PAM - 13®）进行评估。对122名患者的回答进行了描述性统计、t检验、方差分析、线性建模、卡方检验和二元回归分析。
在0 - 100的量表上，患者激活的平均得分为56.12（标准差12.82），其中≤55.1表示激活程度低。较低的激活得分与老年、肥胖、孤独以及较低的感知健康、功能能力和活力显著相关。激活程度低的患者（47%）在身体活动、饮食、护理依从性和健康相关生活质量方面明显较差，并且在与自我管理相关的认知方面，包括动机和精力、正常感以及来自医生、护士和亲密人士的支持方面也明显更差。
多病共存门诊患者的患者激活程度相当低。研究结果表明，患者对自身健康的认知和心理社会因素可能对激活很重要，并且激活程度低和高的患者在几个健康变量方面存在差异。确定多病共存患者的患者激活情况可能有助于调整护理，以更好地满足临床环境中患者的能力和需求。了解患者的激活水平在为该患者群体制定干预措施和护理策略时也可能有用。
