title: Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey.
abstract: OBJECTIVE
  We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease.
  
  
  METHODS
  This was a population-based, cross-sectional survey of 4,343 subjects aged ≥40 years from 12 countries, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. The impact of COPD was measured with COPD Assessment Test, modified Medical Research Council Dyspnea Scale, and hospital admissions and emergency department visits for COPD in the prior year. The 13-item Patient Activation Measure (PAM-13) instrument and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used to measure patient disease engagement and medication adherence, respectively.
  
  
  RESULTS
  Twenty-eight percent of subjects reported being either disengaged or struggling with their disease (low engagement: PAM-13 levels 1 and 2), and 35% reported poor adherence (MMAS-8 <6). In univariate analyses, lower PAM-13 and MMAS-8 scores were significantly associated with poorer COPD-specific health status, greater breathlessness and lower BMI (PAM-13 only), less satisfaction with their doctor's management of COPD, and more emergency department visits. In multivariate regression models, poor satisfaction with their doctor's management of COPD was significantly associated with both low PAM-13 and MMAS-8 scores; low PAM-13 scores were additionally independently associated with higher COPD Assessment Test and modified Medical Research Council scores and low BMI (underweight).
  
  
  CONCLUSIONS
  Poor patient engagement and medication adherence are frequent and associated with worse COPD-specific health status, higher health care utilization, and lower satisfaction with health care providers. More research will be needed to better understand what factors can be modified to improve medication adherence and patient engagement.
authors.affiliation: GSK, Worldwide Epidemiology, Uxbridge, UK.
authors.forename: Hana
authors.initials: H
authors.lastname: Müllerová
authors.affiliation: GSK, Worldwide Epidemiology, Uxbridge, UK.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Landis
authors.affiliation: Pulmonology Research Institute, Moscow, Russia.
authors.forename: Zaurbek
authors.initials: Z
authors.lastname: Aisanov
authors.affiliation: GSK, Worldwide Epidemiology, Upper Providence, PA, USA.
authors.forename: Kourtney J
authors.initials: KJ
authors.lastname: Davis
authors.affiliation: Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ichinose
authors.affiliation: University of Kentucky College of Public Health, Lexington, KY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.affiliation: GSK, Worldwide Epidemiology, Uxbridge, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Maskell
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Menezes
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
authors.affiliation: GSK, Value Evidence Outcomes, Uxbridge, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Tabberer
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA.
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D001993:Bronchodilator Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005060:Europe; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D055118:Medication Adherence; D008800:Mexico; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010358:Patient Participation; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D056910:Republic of Korea; D012307:Risk Factors; D012648:Self Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D001993:Bronchodilator Agents
keywords: adherence; chronic obstructive pulmonary disease; patient engagement; patient survey