Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional

Objective To evaluate the extent of patient activation and factors associated with activation in adults with comorbid diabetes and chronic kidney disease (CKD). Design A cross-sectional study. setting Renal/diabetes clinics of four tertiary hospitals across the two largest states of Australia. study population Adult patients (over 18 years) with comorbid diabetes and CKD (estimated glomerular filtration rate <60 mL/min/1.73 m). Main outcome measures Patients completed the Patient Activation Measure, the Kidney Disease Quality of Life and demographic and clinical data survey from January to December 2014. Factors associated with patient activation were examined using χ or t-tests and linear regression. results Three hundred and five patients with median age of 68 (IQR 14.8) years were studied. They were evenly distributed across socioeconomic groups, stage of kidney disease and duration of diabetes but not gender. Approximately 46% reported low activation. In patients with low activation, the symptom/problem list, burden of kidney disease subscale and mental composite subscale scores were all significantly lower (all p<0.05). On multivariable analysis, factors associated with lower activation for all patients were older age, worse selfreported health in the burden of kidney disease subscale and lower self-care scores. Additionally, in men, worse self-reported health in the mental composite subscale was associated with lower activation and in women, worse self-reported health scores in the symptom problem list and greater renal impairment were associated with lower activation. conclusion Findings from this study suggest that levels of activation are low in patients with diabetes and CKD. Older age and worse self-reported health were associated with lower activation. This data may serve as the basis for the development of interventions needed to enhance activation and outcomes for patients with diabetes and CKD. IntrODuctIOn Patient activation may be defined as the ability and willingness of patients to take on the role of managing their own health and healthcare and is related to the degree that a patient participates or engages in specific health behaviours. Previous studies of patients with hypertension in primary care settings suggest that patient activation is associated with patient outcomes, where low activated patients are more likely to smoke, have a higher body mass index (BMI) and less likely to achieve cholesterol and glycated haemoglobin targets. In patients with diabetes, high activation has been associated with greater engagement in exercise, fewer hospitalisations and improved glycaemic control. In patients with hypertension 10 11 and chronic kidney disease (CKD) high activation is associated with better blood pressure control and in patients with end-stage kidney disease higher activation is likely to improve uptake of home dialysis. Low activation levels have been reported in 25%–40% of the general population and in patients living with chronic diseases. 15 16 However, activation levels may vary considerably depending on the severity of the chronic disease. 18 Indeed, little is known about the Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study Edward Zimbudzi, Clement Lo, Sanjeeva Ranasinha, Gregory R Fulcher, Stephen Jan, Peter G Kerr, Kevan R Polkinghorne, Grant Russell, Rowan G Walker, Sophia Zoungas To cite: Zimbudzi E, Lo C, Ranasinha S, et al. Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a crosssectional study. BMJ Open 2017;7:e017695. doi:10.1136/