Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey

• Published in: International journal of chronic obstructive pulmonary disease Vol. 11; no. 1; pp. 881 - 890
• Main Authors: Müllerová, Hana, Landis, Sarah H, Aisanov, Zaurbek, Davis, Kourtney J, Ichinose, Masakazu, Mannino, David M, Maskell, Joe, Menezes, Ana M, van der Molen, Thys, Oh, Yeon-Mok, Tabberer, Maggie, Han, MeiLan K
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2016; Dove Medical Press Ltd; Dove Medical Press
• Subjects: adherence; Adult; Aged; Brazil; Bronchitis; Bronchodilator Agents - therapeutic use; Chi-Square Distribution; Chronic illnesses; Chronic obstructive pulmonary disease; Confidence; Councils; Cross-Sectional Studies; Disease Progression; Emergency Service, Hospital; Europe; Female; Health Behavior; Health Care Surveys; Health Knowledge, Attitudes, Practice; Health Status; Health surveys; Humans; Logistic Models; Lung - drug effects; Lung - physiopathology; Lung diseases, Obstructive; Male; Medical research; Medication Adherence; Medicine, Experimental; Mexico; Middle Aged; Multivariate Analysis; Odds Ratio; Original Research; Patient Admission; Patient admissions; Patient compliance; patient engagement; Patient Participation; Patient Satisfaction; patient survey; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - therapy; Republic of Korea; Review boards; Risk Factors; Self Care; Severity of Illness Index; Surveys; Surveys and Questionnaires; Time Factors; Treatment Outcome; United States; United States > US; Japan; patient survey; patient engagement; adherence; chronic obstructive pulmonary disease
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S102280

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.
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.
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).
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.