Meeting NewsPerspective

IBD patients with high ‘patient activation’ less likely to flare

Edward Barnes, MD
Edward Barnes

LAS VEGAS — Patients with inflammatory bowel disease who showed high levels of “patient activation” were less likely to experience disease flare during follow-up, according to new research presented at the Crohn’s & Colitis Congress.

Investigators called on their colleagues to consider interventions to increase patient activation and potentially improve outcomes.

Patient activation is defined as understanding one’s role in the health care process and having the knowledge, skills and confidence to manage one’s health,” Edward Barnes, MD, MPH assistant professor of medicine in the division of gastroenterology and hepatology at University of North Carolina, Chapel Hill, said during his presentation. This relatively novel concept in IBD “emphasizes an individuals’ willingness to take independent actions and manage their own health care.”

Higher levels of patient activation have been linked to improved health outcomes, better patient experiences, higher quality of life scores, and lower overall health care costs in many chronic conditions, Barnes said. However, it has not been extensively studied in IBD, though “patients with IBD have indicated an increasing desire to be involved in their care,” he added.

To evaluate whether patient activation impacts remission in IBD, Barnes and colleagues performed a prospective study of 1,486 participants in the Crohn’s and Colitis Foundation’s Partners Internet cohort, who completed a 13-question validated survey called the Patient Activation Measure, and were then followed for 6 months to a year (mean age, 43.8 years; 74% women).

The Patient Activation Measure stratifies patients into four levels of activation, with levels 3 and 4 considered “high”:

  1. the patient believes an active role is important;
  2. the patient has the confidence and knowledge to take action;
  3. the patient takes action; and
  4. the patient stays the course.

 

Overall, 73% of patients with follow-up data were included in the final analysis (65% with Crohn’s disease, 35% with ulcerative colitis; median follow-up, 189 days). At follow-up, 63% of patients were in remission.

Barnes and colleagues found that patients with higher patient activation showed increased odds of being in clinical remission at follow-up, after adjusting for educational status and other confounders. This association was significant for both Crohn’s disease (adjusted odds ratio [aOR] = 1.6; 95% CI, 1-2.57) and ulcerative colitis (aOR = 2.23; 95% CI, 1.19-4.15).

Among patients with Crohn’s disease, 71% with high patient activation vs. 62% with low patient activation were in remission in follow-up, and among patients with UC, 54% vs. 34% were in remission.

Barnes and colleagues also found that patients whose highest level of education was less than 12th grade showed a significantly lower likelihood of having high patient activation compared with those who completed higher education. Non-white race was also associated with lower odds of high patient activation, but this was not significant in the adjusted model, Barnes noted.

“Patient activation appears to impact the disease course of both patients with Crohn’s disease and ulcerative colitis, and the effect of patient activation on the disease course may be greater in ulcerative colitis than in Crohn’s disease,” Barnes said.

Given that tailored interventions to improve patient activation have been associated with improved outcomes in other chronic diseases, efforts to improve patient activation in patients with IBD may have the ability to improve outcomes as well, he concluded. – by Adam Leitenberger

Reference:

Barnes E, et al. Abstract 12. Presented at: Crohn’s & Colitis Congress; Jan. 19-20, 2018; Las Vegas, NV.

Disclosures: Barnes reports no relevant financial disclosures. Please see the full abstract for all other authors’ relevant financial disclosures.

Edward Barnes, MD
Edward Barnes

LAS VEGAS — Patients with inflammatory bowel disease who showed high levels of “patient activation” were less likely to experience disease flare during follow-up, according to new research presented at the Crohn’s & Colitis Congress.

Investigators called on their colleagues to consider interventions to increase patient activation and potentially improve outcomes.

Patient activation is defined as understanding one’s role in the health care process and having the knowledge, skills and confidence to manage one’s health,” Edward Barnes, MD, MPH assistant professor of medicine in the division of gastroenterology and hepatology at University of North Carolina, Chapel Hill, said during his presentation. This relatively novel concept in IBD “emphasizes an individuals’ willingness to take independent actions and manage their own health care.”

Higher levels of patient activation have been linked to improved health outcomes, better patient experiences, higher quality of life scores, and lower overall health care costs in many chronic conditions, Barnes said. However, it has not been extensively studied in IBD, though “patients with IBD have indicated an increasing desire to be involved in their care,” he added.

To evaluate whether patient activation impacts remission in IBD, Barnes and colleagues performed a prospective study of 1,486 participants in the Crohn’s and Colitis Foundation’s Partners Internet cohort, who completed a 13-question validated survey called the Patient Activation Measure, and were then followed for 6 months to a year (mean age, 43.8 years; 74% women).

The Patient Activation Measure stratifies patients into four levels of activation, with levels 3 and 4 considered “high”:

  1. the patient believes an active role is important;
  2. the patient has the confidence and knowledge to take action;
  3. the patient takes action; and
  4. the patient stays the course.

 

Overall, 73% of patients with follow-up data were included in the final analysis (65% with Crohn’s disease, 35% with ulcerative colitis; median follow-up, 189 days). At follow-up, 63% of patients were in remission.

Barnes and colleagues found that patients with higher patient activation showed increased odds of being in clinical remission at follow-up, after adjusting for educational status and other confounders. This association was significant for both Crohn’s disease (adjusted odds ratio [aOR] = 1.6; 95% CI, 1-2.57) and ulcerative colitis (aOR = 2.23; 95% CI, 1.19-4.15).

Among patients with Crohn’s disease, 71% with high patient activation vs. 62% with low patient activation were in remission in follow-up, and among patients with UC, 54% vs. 34% were in remission.

Barnes and colleagues also found that patients whose highest level of education was less than 12th grade showed a significantly lower likelihood of having high patient activation compared with those who completed higher education. Non-white race was also associated with lower odds of high patient activation, but this was not significant in the adjusted model, Barnes noted.

“Patient activation appears to impact the disease course of both patients with Crohn’s disease and ulcerative colitis, and the effect of patient activation on the disease course may be greater in ulcerative colitis than in Crohn’s disease,” Barnes said.

Given that tailored interventions to improve patient activation have been associated with improved outcomes in other chronic diseases, efforts to improve patient activation in patients with IBD may have the ability to improve outcomes as well, he concluded. – by Adam Leitenberger

Reference:

Barnes E, et al. Abstract 12. Presented at: Crohn’s & Colitis Congress; Jan. 19-20, 2018; Las Vegas, NV.

Disclosures: Barnes reports no relevant financial disclosures. Please see the full abstract for all other authors’ relevant financial disclosures.

    Perspective
    David T. Rubin

    David T. Rubin

    This presentation was on an interesting topic called “patient activation.”

    Edward Barnes, MD, who is an advanced IBD fellow at the University of North Carolina, used the Crohn’s & Colitis Foundation Partners Database, which is a survey access internet-based database for patients to address the “patient activation” issue.

    Barnes and colleagues used a validated instrument called the Patient Activation Measure to assess patients’ levels of activation, which refers to their behavioral willingness to make changes. The example he used in his presentation had to do with smoking cessation.

    It was very interesting to be able to assess how patients are either activated or not activated as it may relate to being adherent to therapy, making changes in their lifestyle and treating their disease, and how we might learn from this to develop some customized interventions to help patients become more in touch with their disease and more self-reliant.

    This is a really interesting topic — excellent presentation by Barnes and his colleagues, and a great use of the Crohn’s and Colitis Foundation’s resource.

    • David T. Rubin, MD
    • Professor of Medicine University of Chicago Medicine

    Disclosures: Rubin reports no relevant financial disclosures.

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