title: Patient activation and improved outcomes in HIV-infected patients.
abstract: BACKGROUND
  The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression.
  
  
  OBJECTIVE
  To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  433 patients receiving care in four HIV clinics.
  
  
  METHODS
  An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications.
  
  
  METHODS
  Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence.
  
  
  RESULTS
  Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL(3) (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence.
  
  
  CONCLUSIONS
  Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.
authors.affiliation: Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Marshall
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.forename: Tomi
authors.initials: T
authors.lastname: Mori
authors.forename: Mark O
authors.initials: MO
authors.lastname: Loveless
authors.forename: Judith H
authors.initials: JH
authors.lastname: Hibbard
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cohn
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Sharp
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011594:Psychometrics; D012648:Self Care / Q000592:standards*; D020377:Self Efficacy; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents