Who participates in Chronic Disease Self-management (CDSM) programs? Differences between participants and nonparticipants in a population of multimorbid older adults

摘要

BACKGROUND: Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES: To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN: Participants in the intervention arm of a matched-pair cluster-randomized controlled trial of the Guided Care model were invited to attend a 6-session CDSM course. Logistic regression was used to identify factors independently associated with attendance. SUBJECTS: All subjects (N=241) were aged 65 years or older, were at high risk for health care utilization, and were not homebound. MEASURES: Baseline information on demographics, health status, health activities, and quality of care was available for CDSM participants and nonparticipants. Participation was defined as attendance at 5 or more CDSM sessions. RESULTS: A total of 22.8% of multimorbid older adults who were invited to CDSM courses participated in 5 or more sessions. Having better physical health (odds ratio [95% confidence interval]=2.3 [1.1-4.8]) and rating one's physician poorly on support for patient activation (odds ratio [95% confidence interval]=2.8 [1.3-6.0]) were independently associated with attendance. CONCLUSIONS: Multimorbid older adults who are in better physical health and who are dissatisfied with their physicians' support for patient activation are more likely to participate in CDSM courses.