Increased Patient Activation Is Associated with Fewer Emergency Room Visits and Hospitalizations for Pain in Adults with Sickle Cell Disease

Abstract Objective Recurrent vaso-occlusive pain episodes, the most common complication of sickle cell disease (SCD), cause frequent health care utilization. Studies exploring associations between patient activation and acute health care utilization for pain are lacking. We tested the hypothesis tha...

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Vydané v:	Pain medicine (Malden, Mass.) Ročník 20; číslo 8; s. 1464 - 1471
Hlavní autori:	Cronin, Robert M, Dorner, Tim Lucas, Utrankar, Amol, Allen, Whitney, Rodeghier, Mark, Kassim, Adetola A, Jackson, Gretchen Purcell, DeBaun, Michael R
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England Oxford University Press 01.08.2019
Predmet:	Addictive behaviors Adolescent Adult Adults African Americans Analysis Anemia, Sickle Cell - physiopathology Anemia, Sickle Cell - therapy Antisickling Agents - therapeutic use Blood Transfusion Care and treatment Cross-Sectional Studies Demography Editor's Choice Emergency medical care Emergency service Emergency Service, Hospital - statistics & numerical data Female GENERAL & SELECTED POPULATIONS SECTION Health care reform Health services utilization Hospitalization - statistics & numerical data Hospitals Humans Hydroxyurea - therapeutic use Hypotheses Male Medical care Medical centers Medical research Medicine, Experimental Middle Aged Opioid-Related Disorders Pain Pain - physiopathology Pain Management Patient Participation Patients Phenotypes Self Efficacy Sickle cell anemia Sickle cell disease Utilization Young Adult Tennessee Self-Efficacy Hospitalizations Health Care Utilization Sickle Cell Disease Patient Activation Acute Pain Vaso-occlusive Pain Episodes Chronic Care Model
ISSN:	1526-2375, 1526-4637, 1526-4637
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Shrnutí:	Abstract Objective Recurrent vaso-occlusive pain episodes, the most common complication of sickle cell disease (SCD), cause frequent health care utilization. Studies exploring associations between patient activation and acute health care utilization for pain are lacking. We tested the hypothesis that increased activation and self-efficacy are associated with decreased health care utilization for pain in SCD. Methods In this cross-sectional study of adults with SCD at a tertiary medical center, we collected demographics, SCD phenotype, Patient Activation Measure levels, and self-efficacy scores using structured questionnaires. We reviewed charts to obtain disease-modifying therapy and acute health care utilization, defined as emergency room visits and hospitalizations, for vaso-occlusive pain episodes. Negative binomial regression analyses were used to test the hypothesis. Results We surveyed 67 adults with SCD. The median age was 27.0 years, 53.7% were female, and 95.5% were African American. Median health care utilization for pain over one year (range) was 2.0 (0–24). Only one-third of participants (38.8%) were at the highest activation level (median [range] = 3 [1–4]). Two-thirds (65.7%) of participants had high self-efficacy (median [range] = 32.0 [13–45]). Regressions showed significant association between health care utilization and activation (incidence rate ratio [IRR] = 0.663, P = 0.045), self-efficacy (IRR = 0.947, P = 0.038), and male sex (IRR = 0.390, P = 0.003). Two outliers with high activation, self-efficacy, and health care utilization also had addictive behavior. Conclusions Many individuals with SCD have suboptimal activation and reduced self-efficacy. Higher activation and self-efficacy were associated with lower health care utilization for pain. Additional studies are needed to evaluate interventions to improve activation and self-efficacy and reduce acute health care utilization for pain.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	1526-2375 1526-4637 1526-4637
DOI:	10.1093/pm/pny194