patient empowerment impacts medication adherence among hiv-positive patients in the veteran’s...

Patient Empowerment Impacts Medication Adherence among HIV-Positive Patients in the Veteran’s Health Administration

Tan Pham1,2,3, Kristin Mattocks1,2, Jane Ungemack3, Marysol Asencio3, Amy Justice1,2

(1) VA Connecticut Health Care System; (2) Yale University School of Medicine; (3) University of Connecticut

Method: This study is a cross-sectional analysis study using the first survey from the patient’s first entry into the Veterans Aging Cohort Study (VACS). VACS is a longitudinal, prospective multisite observational study of HIV infected and uninfected patients seen in Veteran’s Health Administration infectious disease and general clinics. Medication Adherence was calculated using Steiner’s general method of compliance assessment using patient’s pharmacy records

To assess active knowledge seeking, the following two 4-point statements were combined: “I want to take an active role in the medical management of my HIV infection and its complications” and “I want to know as much as I can about the medical aspects of my HIV condition and treatment.” Cronbach’s α for the scale was .68.

To assess decision-making involvement, the following two 4 point statements were combined: “It is better to trust a doctor or nurse in charge of a medical procedure than to question what they are doing” and “I’d rather have doctors and nurses make decisions about what’s best than for them to give me a lot of choices.” These two statements were combined into a four-point scale where a higher score would indicate strong desire for decision-making involvement (empowerment). Cronbach’s α for the scale was .78.

Social support is measured by how often the patient sees their relatives and how often the patient sees their close friends. Both questions were combined into a five-point scale. Cronbach’s α for the scale was .60.

Analysis: Univariate statistics were used to describe the patient characteristics. A multiple logistic regression model was used to determine the impact of patient empowerment on medication adherence while adjusting for patient characteristics. Medication Adherence is defined as pharmacy refilled greater than 80%.

Background•To examine the relationship between patient empowerment and highly active antiretroviral (HAART) medication adherence

Objectives

Methods

Over the last 30 years, there has been an increasing trend in patient empowerment where patients are ‘taking charge’ of their own disease management and their interaction with medical providers. Patients who are empowered are active knowledge seekers and/or are involved in their treatment decision-making. These empowered behaviors have been shown to have positive health outcomes in other chronic diseases. For HIV-positive patients, a positive health outcome can be achieved through HIV mediation adherence at least 80%. Little research has been conducted on patient empowerment and medication adherence among HIV-infected patients.

Table 2: Odds of Medication Adherence by Patient Empowerment, Patient Demographics, Substance and Mental Health Characteristics among HIV-positive patients

Variable Adjusted Odds Ratio

95% CI

Patient Empowerment Active Knowledge Seeking Decision-Making Involvement

1.1181.061

(1.020,1.374)(1.012,1.175)

Age 1.023 (1.012,1.034)

Race and Ethnicity Caucasian African American Hispanic

Reference0.5350.552

-----(0.430,0.666)(0.390,0.780)

Gender Male Female

Reference0.874

-----(0.480,1.588)

Education 1.073 (1.003,1.145)

Income 1.003 (0.924,1.089)

Patient Satisfaction 1.097 (1.058,1.166)

Social Support 0.966 (0.894,1.044)

Disease Severity Viral Load CD4 Count

1.0001.001

(1.000,1.000)(1.000,1.001)

Mental Health Major Depression Minor Depression PTSD Bipolar Disorder Anxiety

1.0331.0041.2450.8910.800

(0.758,1.408)(0.757,1.331)(0.851,1.823)(0.552,1.440)(0.524,1.222)

Substance Abuse Drug Abuse Alcohol Abuse

1.0380.930

(0.786,1.370)(0.672,1.286)

Results

Patients who are more empowered (active knowledge seeking and decision-making involvement) are more likely to be adherent to their medication.

Consistent with the literature on medication adherence on other chronic diseases, age and education are positively associated with medication adherence.

Additional research is needed focusing on patient empowerment, HIV medication adherence and comorbidities to better understand this relationship.

Discussion

Acknowledgements

Table 1: HIV Positive Patient Characteristics

Demographic Percentage(n=3272)

Age [mean] 49Race/Ethnicity Hispanic Caucasian African American

10%20%70%

Gender Female Male

3%97%

Education <High School High School/GED Some College College Graduate Graduate School

7%34%44%10%5%

Income <$6,000 $6,000-$11,999 $12,000-$24,999 $25,000-$49,999 $50,000+

20%31%25%18%7%

Medication Adherence [mean] 80% This research project was conducted as apart of Tan Pham’s Master of Public Health thesis at the University of Connecticut. This research data was made available by Dr. Amy Justice’s Veterans Aging Cohort Study.