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Research ArticleOriginal Research

Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities

Elizabeth A. Bayliss, Jennifer L. Ellis and John F. Steiner
The Annals of Family Medicine September 2007, 5 (5) 395-402; DOI: https://doi.org/10.1370/afm.722
Elizabeth A. Bayliss
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Jennifer L. Ellis
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John F. Steiner
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    Figure 1.

    How barriers may affect health outcomes.

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    Table 1.

    Characteristics of Study Population, N = 352

    No. (%)
    CharacteristicRespondents* N=352Nonrespondents* N=394
    GED = general equivalency diploma.
    * Used χ2 (categorical) and Wilcoxon rank sum (continuous) tests for comparisons between respondents and nonrespondents.
    † Significant at P=.010.
    ‡ Used observation period of 1 year before survey date for respondents and 1 year before median survey date for nonrespondents.
    Male124 (35)126 (32)
    Age-group, y
        65–74193 (55)182 (46)†
        75+159 (45)212 (54)†
    Mean Quan morbidity score (SD)‡4.6 (3.3)4.2 (2.8)
    Mean months in health plan (SD)166 (86)157 (83)
    Education
        Some high school or less36 (10)
        High school graduate/GED124 (35)
        Some college/2-y degree109 (31)
        4-y college graduate or more78 (22)
    Marital status
        Married187 (53)
        Divorced/separated50 (14)
        Never married6 (2)
        Widowed103 (29)
    Race
        Black/African American7 (2)
        White306 (90)
        Other29 (8)
    Ethnicity
        Hispanic/Latino37 (11)
        Non-Hispanic/Latino308 (88)
    Income
        <$45,000269 (76)
        $45,000+59 (17)
    Subjective health status
        Excellent5 (1)
        Very good39 (11)
        Good132 (38)
        Fair125 (36)
        Poor51 (14)
    • View popup
    Table 2.

    Barriers to Self-Management Reported by Study Participants: Bivariate (Spearman) Correlations With Outcomes

    Correlation Coefficients
    Potential Barrier to Self-Management*Mean Score (SD)†Health StatusPhysical Functioning
    * Listed in order of addition to multivariate models.
    † Scales 0 to 100 except as noted. Higher scores are consistent with being better off for a given domain, eg, better knowledge, fewer financial constraints, better patient-clinician communication.
    ‡ P ≤ 001.
    § P ≤ 01.
    || P ≤ 05.
    Count of diseases (no scale)8.7 (2.7)−0.41‡− 0.38‡
    Persistent depressive symptoms (yes/no: 0.0–1.0)0.6 (0.5)− 0.32‡− 0.25‡
    Physical functioning43.6 (27.3)0.55‡…
    Self-efficacy71.6 (19.3)0.31‡0.28‡
    Health literacy74.9 (21.4)0.16§0.12||
    Disease burden19.5 (10.3)− 0.51‡− 0.51‡
    Compound effects of conditions60.2 (15.8)0.32‡0.23‡
    Overwhelmed by 1 condition68.3 (23.4)0.31‡0.25‡
    Knowledge about conditions55.9 (27.9)0.24‡0.07
    Financial constraints66.4 (26.3)0.34‡0.32‡
    Social activity71.9 (21.1)0.26‡0.24‡
    Patient-clinician communication82.5 (17.9)0.23‡0.08
    Medication knowledge78.7 (16.1)0.18§0.09
    Medication adherence77.8 (20.7)0.17§0.15§
    Compound effects of medications55.3 (17.4)0.100.06
    • View popup
    Table 3.

    Multivariate Model: Barriers to Self-Management Associated With Lower Health Status

    Health Status*CoefficientP Value
    Note: R2 for model = 0.447; n = 332.
    * All scales 0 to 100 unless noted.
    Intercept−19.000.002
    Disease burden/level of morbidity (range, 1–59)0.523<.001
    Physical function−0.331<.001
    Knowledge of medical conditions−0.098.006
    Social activity−0.101.033
    Persistent depressive symptoms (yes/no)4.451.035
    Financial constraints−0.082.046
    Male sex4.182.045
    • View popup
    Table 4.

    Multivariate Model: Barriers to Self-Management Associated With Lower Levels of Physical Functioning

    Physical Function*CoefficientP Value
    Note: R2 for model = 0.341; n = 343.
    * All scales 0 to 100 unless noted.
    † Significance accounted for by interaction terms.
    Intercept−44.406.005
    Disease burden/level of morbidity0.173.790†
    Financial constraints− 0.434<.001
    Income−11.437<.001
    Patient-clinician communication0.455.007
    Compound effects of conditions− 0.509.009
    Persistent depressive symptoms6.111.021
    Disease burden X patient-clinician communication− 0.020.010
    Disease burden X financial constraints0.018<.001
    Disease burden X compound effects of conditions0.025.007

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    Barriers to Self-Management and Quality of Life Outcomes in Seniors With Multimorbidities

    Elizabeth A. Bayliss, MD, MSPH , and colleagues

    Background In this study, seniors with chronic diseases were surveyed about barriers that prevent them from caring for themselves and that contribute to a sense of worse health.

    What This Study Found Three-hundred fifty-two seniors completed the survey questionnaire and had an average of 8.7 chronic diseases. The following barriers to self-care, which were identified by the participants, are related to worse health: more chronic health conditions, lower level of physical functioning, less knowledge about medical conditions, less social activity, ongoing depression, financial difficulties, and male sex. These barriers could be addressed by identifying and treating depression, educating patients about their medical conditions; increased physical therapy and other support, ensuring that symptoms and treatments for separate conditions do not interfere with each other, and coordinating patient care while taking into account patients� financial resources.

    Implications

    • Medical care that emphasizes management of individual diseases may not meet the needs of patients with multiple chronic conditions.
    • Psychosocial factors should be taken into account when caring for patients with multiple chronic conditions.
    • Clinicians need to identify the individual needs of patients with chronic illnesses, help match those needs with resources, and periodically reassess to determine whether their needs have changed.
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The Annals of Family Medicine: 5 (5)
The Annals of Family Medicine
Vol. 5, Issue 5
1 Sep 2007
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Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities
Elizabeth A. Bayliss, Jennifer L. Ellis, John F. Steiner
The Annals of Family Medicine Sep 2007, 5 (5) 395-402; DOI: 10.1370/afm.722

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Barriers to Self-Management and Quality-of-Life Outcomes in Seniors With Multimorbidities
Elizabeth A. Bayliss, Jennifer L. Ellis, John F. Steiner
The Annals of Family Medicine Sep 2007, 5 (5) 395-402; DOI: 10.1370/afm.722
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