title: Influence of patient-assessed quality of chronic illness care and patient activation on health-related quality of life.
abstract: OBJECTIVE
  To examine the association of the Patient Assessment of Chronic Illness Care (PACIC) with health-related quality of life (HRQoL) and the modulating effect of patient activation on this association.
  
  
  METHODS
  A population-based prospective cohort study of people with Type 2 diabetes in Queensland, Australia, using data from self-report questionnaires, collected annually from 2008 (n = 3761) to 2010 (n = 3040).
  
  
  METHODS
  Predictors were the 20-item PACIC (dichotomized at the score of 3), and the 13-item Patient Activation Measure (PAM), dichotomized into activation Levels 1 and 2 versus Levels 3 and 4. Analyses were restricted to participants whose PACIC and PAM categories did not change over 2 years of follow-up. Outcome variables were EQ-5D index and EQ VAS dichotomized at the uppermost quartile, and EQ-5D index also dichotomized at the median.
  
  
  METHODS
  An inverse probability weighted Poisson regression with a log-link function and a binary response variable for each outcome was used to obtain risk ratios (RRs), and the interaction between PACIC and PAM was statistically modelled, taking into consideration patient characteristics and the respective baseline outcome variable.
  
  
  RESULTS
  The positive association between the PACIC and EQ VAS was seen only in participants with low activation (adjusted RR: 3.91; 95% CI: 1.40-10.95; P = 0.009), and not in those with high activation, indicating the non-synergistic interaction effect of the PACIC and PAM. This association was not found with EQ-5D index.
  
  
  CONCLUSIONS
  Chronic care received consistently over time can positively affect health status, and benefit patients with low activation.
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Australia Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Eindra
authors.initials: E
authors.lastname: Aung
authors.affiliation: Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Donald
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Australia.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Williams
authors.affiliation: School of Public Health, University of Queensland, Brisbane, Australia.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Coll
authors.affiliation: Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Suhail A R
authors.initials: SA
authors.lastname: Doi
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D000071066:Patient Reported Outcome Measures; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D011788:Quality of Life; D011793:Queensland; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: EQ-5D; PACIC; chronic illness care; health-related quality of life; patient activation