The effect of a tailored patient activation intervention in inflammatory bowel disease (IBD) patients – a pilot study
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Patient activation may improve medication adherence by equipping patients with skills and knowledge about their disease. There is evidence of a positive relationship between activation and quality of life in IBD patients. However, the impact of a tailored patient activation intervention (PAI) among this group of patients has not been investigated. Activated patients are motivated to be partners in managing their health and would most likely remain in remission for longer periods (in the case of IBD patients). The purpose of this study was to evaluate the effectiveness of a Patient Activation Intervention (PAI) tailored to the needs of individual IBD patients in improving patient activation levels (primary outcome) as well as medication adherence, and satisfaction with medical care. A pre-test, post-test, control group design was employed. IBD patients, who met the inclusion criteria, were selected from medical records via convenience sampling, were consented and completed a baseline survey. They were then categorized into one of four patient activation stages based on responses to the 13-item patient activation measure (PAM-13) at baseline. During their office visit, intervention group patients (N=23) were given a tailored PAI based on their stage which consisted of an information booklet and focused discussion with the gastroenterologist, while the control group (N=27) received usual care. For those who completed both surveys (N=20 intervention group and N=21 control group), baseline scores were compared to 1-month post-intervention scores for changes in patient activation score/stage, medication adherence, and satisfaction with medical care using Chi square and T tests. The majority of participants were Caucasian (88%), female (64%), college graduates (56%), and had Crohn’s disease (59.2%). Averaging across both groups, females had a significantly higher (p=0.04) mean activation score (Mean=70.9, SD=15.4) than males (Mean=60.9, SD=10.7) at baseline and this trend was the same post-intervention (75.6 females vs 64.4 males; p=0.03). The mean activation score difference pre- vs post-intervention for the intervention group (Mean=6.8, SD=12.0) was higher than that of the control group (Mean=1.9, SD=12.5; p=0.21). There was no significant difference in medication adherence or satisfaction scores pre- vs post-intervention for either group. Tailored PAIs have the potential to provide customized medical care to patients (especially those with chronic conditions) and to involve them in their disease management, leading to improved health outcomes.
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