PURPOSE:Although a number of risk factors and severity scores exist for asthma outcomes, few measures include the ability to self manage disease, or “patient activation.” The Patient Activation Measure (PAM-13),1 measures the degree of patient responsibility, confidence, knowledge and skill in self management of disease. It is not clear whether the PAM-13 correlates with asthma outcomes.To assess whether the PAM-13 and perceived cost-related access to medications affect asthma outcomes.
METHODS:Physicians in the Internal Medicine and Pulmonary clinics were educated regarding asthma severity classification per the NHLBI 1997 Asthma Guidelines.2 Surveys of patients aged 18–60 with a history of asthma were then collected from October 2006-January 2008. Variables included demographics, asthma education, severity and control scores, and the PAM-13. Pearson’s correlation coefficient and multivariate regression analyses were performed to assess whether these variables affected asthma outcomes.
RESULTS:Sixty eight surveys were collected. Mean patient age was 43; 76% were female. Although most asthma was classified as mild-moderate persistent, only 39% patients were well-controlled. The mean PAM-13 score was 64 (0–100) and correlated with asthma control (r = -0.27, CI - 0.5 to -.01, p<0.015), but not with hospitalizations or ED visits. Costs prohibiting access to medications was a strong risk factor for ED visits (r = 0.88, CI 0.58–1.2, p<0.001), hospitalizations (r= 0.51, CI 0.34–0.69, p<0.01), and missed days of work (r= 36.9, CI 29.0- 45.3, p<0.01). Previous asthma education did not predict outcomes.
CONCLUSION:The PAM-13 may correlate with asthma control and has the potential to identify interventions that improve asthma management. A prospective study with a larger sample size is required to assess the effect on ED visits and hospitalizations. Perceived prohibitive medication cost correlates with poor outcomes.
CLINICAL IMPLICATIONS:The PAM-13 may be a useful tool to target individualized interventions in asthma care, providing a patient-centered approach to asthma education. Improving access to medications would improve asthma outcomes. 1.Hibbard, JH, et. al. 2005. Health Serv Res 40: 1918–30. 2. Expert Panel Report 2. NHLBIJuly 2007. NIH Publication #97–4051.
DISCLOSURE:Silpa Kilaru, No Financial Disclosure Information; No Product/Research Disclosure Information