THE ASSOCIATION BETWEEN PATIENT CENTEREDNESS EMPOWERMENT AND SELFRATED

THE ASSOCIATION BETWEEN PATIENT CENTEREDNESS, EMPOWERMENT, AND SELFRATED HEALTH JE Rohrer, Ph. D SP Merry, MD, MPH SA Adamson, MD Mayo Clinic, Rochester Department of Family Medicine STFM/AAFP Conference on Practice Improvement Denver, CO November 11, 2006

Objectives Investigate the relationship between health confidence (self-efficacy/empowerment), the feeling that one is in control of one’s health, and patient centered communication (PCC). Investigate the relationship between health confidence (HC) and self-rated health (SRH).

Methods A cross-sectional patient satisfaction phone survey of family medicine patients treated at Mayo Clinic in Rochester, Minnesota (N=800) Convenience sample, >40% response Tested theory that HC is related to patient satisfaction with several aspects of PCC after adjusting for health status, age, and gender, and that HC is related to SRH.

Specific Questions Asked Standard patient satisfaction survey Self-Rated Health--In general, how would you rate your overall health? Health Confidence--In general, how would you rate your ability to take care of your own health without the help of a medical professional?

Previous Research On SRH and HC Medical skepticism HC not previously used as a measure of empowerment Validity of a single question to measure health status is amply supported by prospective studies.

Descriptive Statistics (N=800) Variable % % with High Confidence Total Female Age category 18 -49 50 -64 65 -75 75 and over 100 62. 6 21. 0 22. 3 41. 3 25. 9 16. 6 16. 2 26. 9 15. 9 18. 0 16. 9 p-value . 2198. 0066

Results Being highly satisfied with overall communication, explanations, listening, use of understandable words, and involvement in decisions were positively associated with health confidence. Self-rated health was more strongly related to health confidence than satisfaction with communication in every model tested (AORs ranged from 3. 0 -3. 15).

Six Multiple Logistic Regression Models Of High Health Confidence Rated Care “Excellent” % of Adj OR* (CI) Total for high HC for each PCC Adj OR‡ (CI) for High SRH Quality of Care Communication Explanations Listening Words Decisions 52. 7 59. 6 58. 1 62. 6 62. 5 57. 5 2. 99 (2. 0 -4. 5) 3. 08 (2. 1 -4. 6) 3. 04 (2. 0 -4. 6) 3. 01 (2. 0 -4. 5) 3. 06 (2. 0 -4. 6) 3. 15 (2. 1 -4. 7) 1. 83 (1. 3 -2. 6) 1. 89 (1. 3 -2. 8) 1. 97 (1. 3 -2. 9) 2. 29 (1. 5 -3. 5) 2. 20 (1. 5 -3. 3) 2. 26 (1. 5 -3. 4) *adjusted for age category, gender, and self-rated health ‡adjusted for age category, gender

Conclusions High self-rated health is a better predictor or empowerment than patient centered communication. Promotion of self-rated health may increase empowerment &/or vice versa. Reliance solely on patient centered communication to promote empowerment may be insufficient.

Conclusions PCC HC SRH Empowerment HC and SRH are consistently associated Good overall SRH (as a single item measure) may be used as a patientoriented indicator of the presence of empowerment in cross sectional surveys.

Practice Implications Suggested empowerment strategies: 1) promotion of PCC behaviors (specifically explanations, listening, using understandable language and involving patients in decision-making) 2) health promotion programs (↑HC>PCC) delivered to patient groups, (e. g. , group visits) may increase empowerment more than physician activities (PCC) and are truly patient centered.

Practice Implications 3) Patient satisfaction surveys (admin. data) may provide l Valuable insight into patient centeredness of your practice l Provide prognostic data on patients (SRH in multiple studies is the single more reliable indicator of future mortality) l Provide data on efficiency of your care (PCC and empowered patients are associated with lower health care costs).