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      Health Self-Efficacy Among Populations with Multiple Chronic Conditions: the Value of Patient-Centered Communication

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          Abstract

          Introduction

          Using cross-sectional survey data, we assessed the association between chronic illness burden and health-related self-efficacy, evaluating whether patient-centered communication is associated with self-efficacy and if that relationship varies by chronic illness burden.

          Methods

          Data were from the Health Information National Trends Survey, a cross-sectional survey of the US adult population collected in 2012–2013 ( n = 3630). Health-related self-efficacy was measured with the item: “Overall, how confident are you about your ability to take good care of your health?” and the prevalence of six chronic conditions and depression/anxiety was assessed. Patient-centered communication was measured as the frequency with which respondents perceived their healthcare providers allowed them to ask questions, gave attention to their emotions, involved them in decisions, made sure they understood how to take care of their health, helped them to deal with uncertainty, and if they felt they could rely on their healthcare providers to take care of their healthcare needs.

          Results

          Health-related self-efficacy was significantly lower among individuals with greater illness burden. In adjusted analysis, individuals who experienced more positive patient-centered communication reported higher levels of self-efficacy ( β = 0.26, P < 0.0001); this association was strongest among those with greater illness burden.

          Conclusion

          Higher levels of self-efficacy were observed among patients reporting more positive patient-centered communication; the observed association was stronger among those with greater chronic illness burden.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s12325-016-0369-7) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          Effect of a self-management program on patients with chronic disease.

          For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. To evaluate outcomes of a chronic disease self-management program in a real-world" setting. Before-after cohort study. Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building. Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.
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            Chronic disease self-management program: 2-year health status and health care utilization outcomes.

            To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. Longitudinal design as follow-up to a randomized trial. Community. Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.
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              Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory.

              Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients. We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework. We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature. We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patient-centered care.
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                Author and article information

                Contributors
                rutten.lila@mayo.edu
                Journal
                Adv Ther
                Adv Ther
                Advances in Therapy
                Springer Healthcare (Cheshire )
                0741-238X
                1865-8652
                29 June 2016
                29 June 2016
                2016
                : 33
                : 1440-1451
                Affiliations
                [1 ]Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
                [2 ]Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD USA
                [3 ]Kaiser Permanente Division of Research, Oakland, CA USA
                [4 ]Department of Natural and Applied Sciences, Bentley University, Waltham, MA USA
                [5 ]Department of Family Medicine and Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO USA
                [6 ]Patient Centered Outcomes Research Institute, Washington, DC USA
                Article
                369
                10.1007/s12325-016-0369-7
                4969324
                27357639
                dc5c221f-5843-494d-87b9-de13c001a81f
                © The Author(s) 2016
                History
                : 4 May 2016
                Funding
                Funded by: National Cancer Institute (US)
                Award ID: HHSN261201000064C
                Award Recipient :
                Funded by: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
                Categories
                Original Research
                Custom metadata
                © Springer Healthcare 2016

                multi-morbidity,multiple chronic conditions,patient-centered communication,self-efficacy,survey

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