title: Low self-efficacy is associated with decreased emergency department use in underserved men with prostate cancer.
abstract: BACKGROUND
  Self-efficacy has been strongly associated with health behavior and health maintenance. We examined the relationship between patient-provider self-efficacy and emergency department usage in low-income, underinsured, or uninsured patients with prostate cancer.
  
  
  METHODS
  We prospectively analyzed quality of life, behavior, and self-efficacy data from men enrolled in a state-funded program providing free prostate cancer care. We summarized patient characteristics stratified by self-efficacy scores (high, mid, and low) and by emergency department visit (any vs. none). We conducted a multivariate repeated measures regression analysis with negative binomial distribution to calculate predicted counts of emergency department visits over time across the self-efficacy strata.
  
  
  RESULTS
  Our cohort included 469 men with a maximum follow-up time of 84 months. Of these men, 70 had visited the emergency department during their enrollment for a total of 118 unique visits. The regression analysis demonstrated a decreasing number of emergency department visits over time for the low (P = 0.0633) and mid (P = 0.0450) self-efficacy groups but not for the high self-efficacy group (P = 0.1155). Pain (22.9%), urinary retention (18.6%), and fever (5.9%) were the most common reasons for emergency department visits.
  
  
  CONCLUSIONS
  Patients with low and mid self-efficacy had a decreasing number of emergency department usage over time. Those with high self-efficacy did not follow these trends. Interventions to improve communication between patients and primary treatment teams could prove beneficial in avoiding excess emergency department use.
authors.affiliation: Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA. Electronic address: ABaskin@mednet.ucla.edu.
authors.forename: Avi S
authors.initials: AS
authors.lastname: Baskin
authors.affiliation: Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Connor
authors.affiliation: School of Nursing, University of California, Los Angeles, CA.
authors.forename: Sally L
authors.initials: SL
authors.lastname: Maliski
authors.affiliation: Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D020377:Self Efficacy; D013315:Stress, Psychological / Q000453:epidemiology
keywords: Emergency departments; Health services accessibility; Prostate cancer; Self efficacy; Vulnerable populations