Article Figures & Data
Figures
- Figure 1.
How barriers may affect health outcomes.
Tables
No. (%) Characteristic Respondents* N=352 Nonrespondents* 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. Male 124 (35) 126 (32) Age-group, y 65–74 193 (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 less 36 (10) High school graduate/GED 124 (35) Some college/2-y degree 109 (31) 4-y college graduate or more 78 (22) Marital status Married 187 (53) Divorced/separated 50 (14) Never married 6 (2) Widowed 103 (29) Race Black/African American 7 (2) White 306 (90) Other 29 (8) Ethnicity Hispanic/Latino 37 (11) Non-Hispanic/Latino 308 (88) Income <$45,000 269 (76) $45,000+ 59 (17) Subjective health status Excellent 5 (1) Very good 39 (11) Good 132 (38) Fair 125 (36) Poor 51 (14) - 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 Status Physical 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 functioning 43.6 (27.3) 0.55‡ … Self-efficacy 71.6 (19.3) 0.31‡ 0.28‡ Health literacy 74.9 (21.4) 0.16§ 0.12|| Disease burden 19.5 (10.3) − 0.51‡ − 0.51‡ Compound effects of conditions 60.2 (15.8) 0.32‡ 0.23‡ Overwhelmed by 1 condition 68.3 (23.4) 0.31‡ 0.25‡ Knowledge about conditions 55.9 (27.9) 0.24‡ 0.07 Financial constraints 66.4 (26.3) 0.34‡ 0.32‡ Social activity 71.9 (21.1) 0.26‡ 0.24‡ Patient-clinician communication 82.5 (17.9) 0.23‡ 0.08 Medication knowledge 78.7 (16.1) 0.18§ 0.09 Medication adherence 77.8 (20.7) 0.17§ 0.15§ Compound effects of medications 55.3 (17.4) 0.10 0.06 - Table 3.
Multivariate Model: Barriers to Self-Management Associated With Lower Health Status
Health Status* Coefficient P 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 sex 4.182 .045 - Table 4.
Multivariate Model: Barriers to Self-Management Associated With Lower Levels of Physical Functioning
Physical Function* Coefficient P 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 morbidity 0.173 .790† Financial constraints − 0.434 <.001 Income −11.437 <.001 Patient-clinician communication 0.455 .007 Compound effects of conditions − 0.509 .009 Persistent depressive symptoms 6.111 .021 Disease burden X patient-clinician communication − 0.020 .010 Disease burden X financial constraints 0.018 <.001 Disease burden X compound effects of conditions 0.025 .007
The Article in Brief
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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