Helping people living with HIV learn skills to manage their care
Effects on patient activation were largest among those with lowest baseline patient activation; however, the intervention did not improve ART adherence, viral load, or receipt of evidence-based care. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: Findings were limited by lack of full blinding of part...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
2018, [2018]
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Effects on patient activation were largest among those with lowest baseline patient activation; however, the intervention did not improve ART adherence, viral load, or receipt of evidence-based care. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: Findings were limited by lack of full blinding of participants and research staff. Effects were largest among participants with lowest baseline PAM scores OBJECTIVES: Our primary aim was to assess the impact of the GREAT program on patient activation (using PAM) among PLWH. Secondary outcomes included improvements in eHealth literacy (eHEALS), decision-making self-efficacy (DSES), patient involvement in care (Perceived Involvement in Care Scale [PICS]), patient-reported adherence to antiretroviral therapy (ART) and viral load suppression, health status/quality of life (SF-12), receipt of evidence-based care, and reductions in patient activation disparities. METHODS: We recruited 360 PLWH from 4 practices in greater Rochester, New York, and from 4 federally qualified health centers in the New York City metro area. Participants were randomized 1:1 to the GREAT intervention or control arm. Patients in the control arm received usual care from their HIV clinician during the intervention period and usual care HIV case management assistance based on patient needs and resources available in the practice. BACKGROUND: Patient engagement is the foundation for improving health care, particularly for people living with HIV (PLWH). The Patient Activation Measure (PAM) is a widely used and validated metric for assessing patients' engagement and self-management empowerment. Patient activation is associated with improved adherence, better health outcomes, and lower costs. There is a dearth of scientific data on how to improve patient activation--particularly among individuals with the lowest activation, who are often disproportionately minority, lower-income, older, and less educated than those with higher levels of activation. The Research team used a community-based participatory research approach involving PLWH, HIV clinicians, community-based organizations, and researchers to develop a patient activation program for PLWH. Get Ready and Empowered About Treatment (GREAT) uses a smart, web-enabled device (Apple iPod) with an electronic Personal Health Record (ePHR). We examined bivariate relationships and used mixed models that controlled for site and cohort effects. RESULTS: Participants who were randomized to the intervention had statistically significant improvements in PAM (P < .05). Effects were greatest among those in the lowest quartile for PAM scores at baseline. Significant improvements were also observed for eHealth literacy (P < .001) and involvement in care (P < .05). No statistically significant effects were observed for DSES, ART adherence, confidence in adherence, HIV viral suppression, SF-12, or receipt of evidence-based care. Intervention effects were similar by race/ethnicity and education level except for eHealth literacy, where effects were stronger for minority participants. CONCLUSIONS: A multicomponent intervention improved patient activation and other empowerment-related constructs. Patients in the GREAT training program received six 90-minute group-based training sessions on how to use the iPod and ePHR and how to search the web for health information, and they had a coaching session before their HIV visit. All clinicians received one 60-minute training session focused on supporting patient empowerment. All participants received their own iPod, although participants in the control arm did not receive the iPod until 12 months postrandomization. The primary outcome was changes in the PAM. Secondary outcomes included changes in eHEALS, DSES, PICS, ART adherence and viral suppression, SF-12, and receipt of recommended care (ie, preventive screening, testing, and immunizations received during the 12 months following randomization). Participants were assessed at baseline (T0), 6 to 8 weeks postrandomization (T1), and at the end of the study (T2)--ie, 12 months postrandomization--using data abstracted from charts. |
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| Physical Description: | 1 PDF file (116 pages) illustrations |