The Association between Chronic Diseases and Active Patient Participation

Yang Keun Kim; Hye Won Kim; Jae Yong Paik; Chang Bin Hong; Kayoung Lee; Tae-Jin Park; Jinseung Kim

doi:10.15384/kjhp.2017.17.3.152

Korean J Health Promot > Volume 17(3); 2017 > Article

The Association between Chronic Diseases and Active Patient Participation

Original Article

Korean Journal of Health Promotion 2017;17(3):152-160.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.3.152

The Association between Chronic Diseases and Active Patient Participation

Yang Keun Kim, Hye Won Kim, Jae Yong Paik, Chang Bin Hong, Kayoung Lee, Tae-Jin Park, Jinseung Kim

Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Corresponding author : Jinseung Kim, MD Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea
Tel: +82-51-890-6683, Fax: +82-51-894-7554 E-mail: jinseungkim@inje.ac.kr

Received June 14, 2017 Accepted August 09, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

요약

Background:

Active patient participation in health care decision-making can results in better medical outcomes. This study's purpose is to investigate the association between the patient participation and the diseases often encountered in primary care.

Methods:

We used the data from the Korean National Health and Nutrition Examination Survey conducted in 2015 which included 4,158 adults aged older than 19 and who had no missing data. The association between the presence of disease or the number of accompanying diseases and the active patient participation in the treatment decision was studied. Logistic regression analysis was conducted using complex sampling design in each sex.

Results:

After adjusting for confounding variables, the relationship between active patient participation and the diagnosis of hypertension, odds ratio (OR) was 1.95 (95% confidence interval [CI], 1.25-3.04) for men and 1.83 (95% CI, 1.27-2.65) for women. In women diagnosed with diabetes, OR was 0.58 (95% CI, 0.35-0.97). Between active patient participation and increasing number of accompanying diseases have positive tendency but not statistically significant.

Conclusions:

This study suggests that active patient participation is related to the diagnosis of hypertension, and the number of accompanying diseases and active patient participation were not significantly associated. This is a rare study related to the active patient participation in the Korean population, that it may be helpful in establishing further relevant research and strategies to increase the patient participation rate.

Keywords: Patient participation, Hypertension, Compliance

Figure 1.

Flow chart of subjects’ selection.

Table 1.

The relationships of active patient participation with age, household income, education level, private insurance, and disease

	Men		Women
	% (SE)	P^a	% (SE)	P^a
Age (y)		0.493		0.238
19-29	85.2 (2.5)		84.9 (2.0)
30-39	85.4 (2.6)		89.1 (1.6)
40-49	84.3 (2.7)		87.0 (1.9)
50-59	87.2 (2.3)		87.8 (1.7)
60-69	89.8 (1.7)		89.6 (1.6)
70-79	90.3 (2.3)		91.6 (1.7)
More than 80	90.7 (5.0)		84.9 (4.6)
Household income		0.171		0.459
Low	86.1 (2.5)		89.7 (1.4)
Low-middle	83.6 (2.3)		86.8 (1.4)
High-middle	89.5 (1.7)		88.6 (1.3)
High	85.9 (1.8)		87.0 (1.4)
Education level		0.920		0.179
Less than elementary school	88.0 (2.5)		88.5 (1.6)
Middle school	86.5 (3.1)		92.2 (1.7)
High school	86.7 (1.6)		87.4 (1.4)
College or higher	86.0 (1.6)		86.8 (1.3)
Private insurance		0.995		0.201
Yes	86.5 (1.2)		87.5 (0.8)
No	86.5 (2.0)		89.7 (1.4)
Chronic disease
Diabetes mellitus		0.675		0.454
Yes	87.7 (2.8)		85.9 (2.7)
No	86.4 (1.1)		88.0 (0.8)
Asthma		0.251		0.702
Yes	79.3 (7.0)		86.4 (4.2)
No	86.8 (1.0)		87.9 (0.7)
Hypertension		<0.001		0.001
Yes	92.1 (1.2)		91.9 (1.1)
No	84.9 (1.2)		86.9 (0.9)
Dyslipidemia		0.060		0.332
Yes	90.7 (2.1)		89.5 (1.6)
No	85.9 (1.1)		87.6 (0.9)
Stroke		0.060		0.312
Yes	93.4 (3.8)		91.6 (3.3)
No	86.4 (1.0)		87.8 (0.7)
Angina pectoris or MI		0.136		0.628
Yes	92.7 (3.6)		89.7 (3.5)
No	86.4 (1.0)		87.8 (0.8)
Depression		0.203		0.592
Yes	78.7 (6.9)		86.3 (3.0)
No	86.7 (1.0)		88.0 (0.8)

Abbreviations: MI, myocardial infarction; N, partispants number; SE, standard error.

^aCategorical variables were calculated by chi-square test.

Table 2.

Odds ratio for active patient participation according to the diagnosis of disease by logistic regression

Disease	Sex	Adjusted OR (95% CI)^a	P^b
Diabetes mellitus	Men	0.82 (0.43-1.55)	0.538
Diabetes mellitus	Women	0.58 (0.35-0.97)	0.038
Asthma	Men	0.57 (0.24-1.36)	0.204
Asthma	Women	0.85 (0.41-1.74)	0.649
Hypertension	Men	1.95 (1.25-3.04)	0.003
Hypertension	Women	1.83 (1.27-2.65)	0.001
Dyslipidemia	Men	1.27 (0.72-2.26)	0.408
Dyslipidemia	Women	1.04 (0.66-1.64)	0.863
Stroke	Men	1.66 (0.46-6.01)	0.437
Stroke	Women	1.03 (0.41-2.59)	0.949
Angina pectoris or MI	Men	1.65 (0.58-4.67)	0.346
Angina pectoris or MI	Women	0.90 (0.39-2.06)	0.800
Depressive disorder	Men	0.59 (0.24-1.46)	0.252
Depressive disorder	Women	0.77 (0.44-1.32)	0.337

Abbreviations: OR, odds ratio; CI, confidence interval; MI, myocardial infarction.

^aLogistic regression for active participants according to disease after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, hypertension, dyslipidemia, stroke, angina pectoris or MI, depressive disorder) except for Independent variable.

^bAssessed by logistic regression analysis.

Table 3.

Odds ratio for active patient participation according to the number of diseases by logistic regression

Sex	Number of diseases	Adjusted OR (95% CI)^a
Both (n=4,158)
	0 (n=2,386, 57.4)	1
	1 (n=969, 23.3)	1.12 (0.84-1.50)
	2 (n=526, 12.7)	1.22 (0.81-1.83)
	More than 3 (n=277, 6.7)	1.55 (0.90-2.65)
Men (n=1,702)
	0 (n=958, 56.3)	1
	1 (n=416, 24.4)	1.145 (0.74-1.77)
	2 (n=222, 13.0)	1.376 (0.78-2.44)
	More than 3 (n=106, 6.2)	2.570 (0.94-7.01)
Women (n=2,456)
	0 (n=1,428, 58.1)	1
	1 (n=553, 22.5)	1.11 (0.75-1.65)
	2 (n=304, 12.4)	1.10 (0.62-1.96)
	More than 3 (n=171, 7.0)	1.11 (0.59-2.05)

Abbreviations: OR, odds ratio; CI, confidence interval; n, participants number.

^aLogistic regression for active participants according to the number of diseases after adjustment for age, household incomes, education level, and private insurance.

Table 4.

Analysis of changes in outcome with or without hypertension in dyslipidemia patients

Sex	Control^a	Hypertension without dyslipidemia	Dyslipidemia without hypertension	Dyslipidemia with hypertension
Sex	OR (95% CI)^b
Men	1,099 (64.6)	339 (19.9)	98 (5.8)	166 (9.8)
	1	2.01 (1.24-3.27)	1.32 (0.60-2.94)	2.30 (1.10-4.81)
Women	1,615 (65.8)	337 (13.7)	218 (8.9)	286 (11.6)
	1	1.60 (1.01-2.54)	0.92 (0.54-1.57)	2.19 (1.25-3.83)

Abbreviations: OR, odds ratio; CI, confidence interval. Values are presented as participants number (%) unless otherwise indicated.

^aPatients with diseases except hypertention and dyslipidemia.

^bLogistic regression for active participants according to changes in outcome with hypertension in dyslipidemia patients after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, stroke, angina pectoris or MI, depressive disorder).

Table 5.

Analysis of changes in outcome with or without hypertension in stroke patients

Sex	Control^a	Hypertension without stroke	Stroke without hypertension	Stroke with hypertension
Sex	OR (95% CI)^b
Men	1,181 (69.4)	466 (27.4)	16 (0.9)	39 (2.3)
Men	1	1.88 (1.185-2.981)	0.98 (0.17-5.57)	6.38 (1.40-29.13)
Women	1,821 (74.1)	581 (23.7)	12 (0.5)	42 (1.7)
Women	1	1.84 (1.26-2.68)	1.10 (0.21-5.70)	1.80 (0.61-5.34)

Abbreviations: OR, odds ratio; CI, confidence interval. Values are presented as participants number (%) unless otherwise indicated.

^aPatients with diseases except hypertention and stroke.

^bLogistic regression for active participants according to changes in outcome with hypertension in stroke patients after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, dyslipidemia, angina pectoris or MI, depressive disorder).

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