Abstract
ObjectiveThis study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia.MethodsA cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities.ResultsA total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking.ConclusionIn people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.
Highlights
Among patients with comorbid diabetes and chronic kidney disease (CKD), we have demonstrated an association between patient activation and diabetes self-care activities
A higher patient activation level was associated with a higher overall self-care score
Different patient and disease characteristics were associated with diabetes self-care: younger age and male gender were associated with less home blood glucose monitoring, more severe CKD was associated with less foot checking and exercising, and a shorter duration of diabetes was associated with lower overall self-care score as well as less blood sugar checking and foot checking
Summary
Patient activation specifies the level of patients’ involvement with their health care and refers to the extent to which they have the knowledge, motivation, belief, confidence and skills to manage chronic disease, access health care and to partner with health-care providers for disease management.[1,2,3] Patient activation is an important concept in chronic disease management driven by a person-centred approach and chronic care models.[1,4] Higher levels of patient activation are associated with better patient outcomes compared to lower levels of activation, in chronic diseases.[1,3,5,6,7] Individuals with low activation are more likely to be hospitalized,[8,9] have a longer length of stay in hospital,[10] have greater health-care costs,[11] are less likely to participate in self-management activities such as blood pressure monitoring[12] and have worst care experiences[13] compared to those with higher activation levels. Malea Femaleb Age 68 y Socio-economic status Upper Upper middle Lower middle Upper lower Lower Smoking status Yes No Stage of CKDc 3a 3b 4 5 Dialysis Yes No Diabetes duration 0-8 y 9-18 y 19-25 y 26 y and over Kidney disease duration 5 y. AMissing PAM data for two male participants, not included in analysis; bMissing PAM data for one female participant, not included in analysis; cKidney Disease Outcomes Quality Initiative staging of CKD based on GFR, 3a (45-59), 3b (30-4 4), 4 (15-2 9) 5 (less than 15 or on dialysis); age and CKD duration were stratified by median and diabetes duration by quartiles; *P
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