Patient Enablement in Chronic Diseases in Primary Health Care, Riyadh City, KSA

Rabaa K. Al Momen, Mishal M. Alotaibi, Osama Abdelhay

Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh, KSA.

DOI: 10.4236/ijcm.2015.69082                

Abstract

Background: Chronic diseases continue to cause high morbidity and mortality in Saudi Arabia. Patients severing from diabetes mellitus, hypertension and associated complications have recently increased and most of these patients find it extremely difficult to understand or cope with their illness. The objective of this study is to determine the level of patients’ enablement in chronic disease and its predictors. Methods: A community based cross-sectional study was conducted between December 2014 and January 2015. Six hundred and four (604) Patients attending the Chronic Disease Clinic in Alwazarat Health center were randomly selected to participate in the study. Patients aged 18 years and above, who willingly agreed to participate, were included in the study. Self-reported questionnaire was used to determine patient level of enablement. Descriptive statistics such as mean and median were calculated and binary logistic regression was employed to determine the predictors of patient’s enablement to chronic disease. Results: Our results show that five hundred and sixty five (565) out of (604) patients participated in the study with 86.6% response rate. Type 2 diabetes mellitus affecting 40.65% while hypertension affecting 37.79% of the patients in Al wazarat health center. Patient’s enablement to chronic disease was very low and ranged between 2.41 and 1.53 out of 5.0. Binary logistic regression shows that age (male: OR; 0.84, 95% CI, 0.72 - 1.04, female. OR; 1.04, 95% CI 0.88 - 1.39), marital status (male: OR; 0.72, 95% CI 0.54 - 1.11, female: OR 1.01; 95% CI 0.82 - 1.29), patient educational level and number of problems discussed with physician and consultation length between male patients and their physician were statistically significant and correlated with patients enablement to chronic disease (P < 0.05). Conclusion: This study shows that patient’s enablement in chronic disease is very low but constitutes an important arm in patients care management. It should be considered as a measurable patient outcome from healthcare services. More prospective studies on this important topic are highly recommended.

Keywords

Chronic Disease, Cross-Sectional, Logistic Regression, Enablement, Patient Assessment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Murray, C.J. and Lopez, A.D. (1997) Alternative Projections of Mortality and Disability by Cause 1990-2020: Global Burden of Disease Study. The Lancet, 349, 1498-1504. http://dx.doi.org/10.1016/S0140-6736(96)07492-2
[2]	Mathers, C.D. and Loncar, D. (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Medicine, 3, e442. http://dx.doi.org/10.1371/journal.pmed.0030442
[3]	Gensichen, J., Serras, A., Paulitsch, M., Rosemann, T., König, J., Gerlach, F. and Petersen, J. (2011) The Patient Assessment of Chronic Illness Care Questionnaire: Evaluation in Patients with Mental Disorders in Primary Care. Community Mental Health Journal, 47, 447-453. http://dx.doi.org/10.1007/s10597-010-9340-2
[4]	Hanan, A.-A. and Roland, M. (2005) Quality of Primary Health Care in Saudi Arabia: A Comprehensive Review. International Journal for Quality in Health Care, 17, 331-346. http://dx.doi.org/10.1093/intqhc/mzi046
[5]	Whiting, D.R., Guariguata, L., Weil, C. and Shaw, J. (2011) IDF Diabetes Atlas: Global Estimates of the Prevalence of Diabetes for 2011 and 2030. Diabetes Research and Clinical Practice, 94, 311-321.
[6]	Wensing, M., van Lieshout, J., Jung, H.P., Hermsen, J. and Rosemann, T. (2008) The Patients Assessment Chronic Illness Care (PACIC) Questionnaire in The Netherlands: A Validation Study in Rural General Practice. BMC Health Services Research, 8, 182.
[7]	Novalis, P.N., Rojcewicz, S.J. and Peele, R. (1993) Clinical Manual of Supportive Psychotherapy. American Psychiatric Publishing.
[8]	Brusse, C.J. and Yen, L.E. (2013) Preferences, Predictions and Patient Enablement: A Preliminary Study. BMC Family Practice, 14, 116. http://dx.doi.org/10.1186/1471-2296-14-116
[9]	Rogers, A., Kennedy, A., Nelson, E. and Robinson, A. (2005) Uncovering the Limits of Patient-Centeredness: Implementing a Self-Management Trial for Chronic Illness. Qualitative Health Research, 15, 224-239. http://dx.doi.org/10.1177/1049732304272048
[10]	Shaw, A., Ibrahim, S., Reid, F., Ussher, M. and Rowlands, G. (2009) Patients’ Perspectives of the Doctor-Patient Relationship and Information Giving across a Range of Literacy Levels. Patient Education and Counseling, 75, 114-120. http://dx.doi.org/10.1016/j.pec.2008.09.026
[11]	Andén, A., Andersson, S.-O. and Rudebeck, C.-E. (2009) To Make a Difference—How GPs Conceive Consultation Outcomes. A Phenomenographic Study. BMC Family Practice, 10, 4. http://dx.doi.org/10.1186/1471-2296-10-4
[12]	Rööst, M., Zielinski, A., Petersson, C. and Strandberg, E.L. (2015) Reliability and Applicability of the Patient Enablement Instrument (PEI) in a Swedish General Practice Setting. BMC Family Practice, 16, 31. http://dx.doi.org/10.1186/s12875-015-0242-9
[13]	Kaplan, S.H., Greenfield, S. and Ware Jr., J.E. (1989) Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease. Medical Care, 27, S110-S127. http://dx.doi.org/10.1097/00005650-198903001-00010
[14]	Kurosawa, S., Matsushima, M., Fujinuma, Y., Hayashi, D., Noro, I., Kanaya, T., Watanabe, T., Tominaga, T., Nagata, T. and Kawasaki, A. (2012) Two Principal Components, Coping and Independence, Comprise Patient Enablement in Japan: Cross Sectional Study in Tohoku Area. The Tohoku Journal of Experimental Medicine, 227, 97-104. http://dx.doi.org/10.1620/tjem.227.97
[15]	Glasgow, R.E., Wagner, E.H., Schaefer, J., Mahoney, L.D., Reid, R.J. and Greene, S.M. (2005) Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC). Medical Care, 43, 436-444. http://dx.doi.org/10.1097/01.mlr.0000160375.47920.8c
[16]	O’Donnell, M.P. (2009) Definition of Health Promotion 2.0: Embracing Passion, Enhancing Motivation, Recognizing Dynamic Balance, and Creating Opportunities. American Journal of Health Promotion, 24, 4. http://dx.doi.org/10.4278/ajhp.24.1.iv
[17]	Sprangers, M.A. and Aaronson, N.K. (1992) The Role of Health Care Providers and Significant Others in Evaluating the Quality of Life of Patients with Chronic Disease: A Review. Journal of Clinical Epidemiology, 45, 743-760. http://dx.doi.org/10.1016/0895-4356(92)90052-o
[18]	Atlantis, T. (2004) Association of Outcome with Early Stroke Treatment: Pooled Analysis of ATLANTIS, ECASS, and NINDS rt-PA Stroke Trials. The Lancet, 363, 768-774. http://dx.doi.org/10.1016/S0140-6736(04)15692-4
[19]	Carver, R. and Nash, J. (2011) Doing Data Analysis with SPSS: Version 18.0. Cengage Learning, Belmont.
[20]	Howie, J., Heaney, D.J., Maxwell, M. and Walker, J.J. (1998) A Comparison of a Patient Enablement Instrument (PEI) against Two Established Satisfaction Scales as an Outcome Measure of Primary Care Consultations. Family Practice, 15, 165-171. http://dx.doi.org/10.1093/fampra/15.2.165
[21]	Howie, J.G., Heaney, D.J., Maxwell, M., Walker, J.J., Freeman, G.K. and Rai, H. (1999) Quality at General Practice Consultations: Cross Sectional Survey. BMJ, 319, 738-743. http://dx.doi.org/10.1136/bmj.319.7212.738
[22]	McKinstry, B., Walker, J., Blaney, D., Heaney, D. and Begg, D. (2004) Do Patients and Expert Doctors Agree on the Assessment of Consultation Skills? A Comparison of Two Patient Consultation Assessment Scales with the Video Component of the MRCGP. Family Practice, 21, 75-80. http://dx.doi.org/10.1093/fampra/cmh116
[23]	Adzic, Z.O., Katic, M., Kern, J., Lazic, D., Nekic, V.C. and Soldo, D. (2008) Patient, Physician, and Practice Characteristics Related to Patient Enablement in General Practice in Croatia: Cross-Sectional Survey Study. Croatian Medical Journal, 49, 813-823. http://dx.doi.org/10.3325/cmj.2008.49.813
[24]	Pawlikowska, T., Nowak, P., Szumilo-Grzesik, W. and Walker, J. (2002) Primary Care Reform: A Pilot Study to Test the Evaluative Potential of the Patient Enablement Instrument in Poland. Family Practice, 19, 197-201. http://dx.doi.org/10.1093/fampra/19.2.197
[25]	Howie, J.G., Heaney, D.J., Maxwell, M., Walker, J.J. and Freeman, G.K. (2000) Developing a “Consultation Quality Index” (CQI) for Use in General Practice. Family Practice, 17, 455-461. http://dx.doi.org/10.1093/fampra/17.6.455
[26]	Gray, D.P., Evans, P., Sweeney, K., Lings, P., Seamark, D., Seamark, C., Dixon, M. and Bradley, N. (2003) Towards a Theory of Continuity of Care. Journal of the Royal Society of Medicine, 96, 160-166. http://dx.doi.org/10.1258/jrsm.96.4.160