• Rebecca Marshall, Mary Catherine Beach, Somnath Saha, Tomi Mori, Mark O Loveless, Judith H Hibbard, Jonathan A Cohn, Victoria L Sharp, and P Todd Korthuis.
• Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
• J Gen Intern Med. 2013 May 1; 28 (5): 668674668-74.

BackgroundThe Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression.ObjectiveTo determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients.DesignCross-sectional survey.Participants433 patients receiving care in four HIV clinics.MethodsAn interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications.Main MeasuresPatient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence.Key ResultsOverall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL(3) (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence.ConclusionsHigher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

27 keywords...

hide…