Kronik Hastalıklarda Hasta Aktifliği: Kavram Analizi

Öz

Kronik hastalıklar, dünyada ölüm nedenlerinin başında yer almakta ve sağlık harcamalarının büyük kısmı bu hastalıkların tedavisi için yapılmaktadır. Ölüm oranlarının azaltılması, kronik hastalığın etkili yönetimi ile mümkündür, ancak hastalar genellikle tıbbi bakımda yer almamakta, yer almayı da beklememektedirler. Araştırmalar hastalık yönetiminde aktif olarak yer alan bireylerin, daha fazla öz bakım davranışı gösterdiklerini ve daha iyi sağlık çıktıları ortaya koyduklarını göstermektedir. Hasta aktifliği özellikle kronik hastalığı olan bireylerde önemlidir, çünkü bireylerin, tedavi rejimlerini takip etmeleri, durumlarını gözlemlemeleri, yaşam şekli değişiklikleri yapmaları ve karar verici rolde olmaları gerekir. Kavram analizi rehberliğinde yazılan bu çalışmada kronik hastalıkların Türkiye ve dünyadaki durumu, kronik hastalık yönetiminde hasta aktifliği ve aktif hasta yönetiminin bakıma etkisini ele alan literatür taranmıştır. Sonuç olarak, bakım gereksinimlerini ve bakım çıktılarını belirlemede, en büyük rolün hastaya ait olduğu, bireylerin aktiflik düzeyinin - sağlık davranışını yapıp sürdürebileceğine dair inancının, bilgi ve beceri düzeyinin, motivasyonunun - bilinmesinin, bireye özgü girişimlerin planlanmasını destekleyeceği görülmüştür.

Anahtar Kelimeler

• Hasta aktifliği, öz yönetim, öz bakım, sağlık davranışları, kronik hastalık yönetimi.

Patient Activation in Chronic Diseases: Concept Analyse

Öz

Chronic diseases are the most leading cause of death in the world and also most of the health expenditure is used for treatment of chronic diseases. Reduction of the death rates is possible with the effective management of chronic disease, but patients generally don’t participate and also don’t expect to participate in medical care. A number of researchers have found patient, who participate in ilness management actively, perform more self care behaviours and present better health outcomes. Patient activation especially important for individuals who have chronic disease; because they need to pursue their medical treatments, observe their conditions, do life style changes and be in a decision making role. Concept analysis method is used in this study and literature about the situation of Chronic diseases in Turkey also in the World, patient activation in chronic disease management and effect of active patient management on care is scanned and examined. As a result, determining the care requirements and outcomes, the most important role is belong to patient. When patient’s activation level - belief about doing and maintaining the health behaviour, informaton and skill level, motivation status - are known, individualized care plans can be tailored

Anahtar Kelimeler

• Patient activation, self management, self care, health behaviours, chronic disease management.

Kaynakça

1. Alegría, M. , Sribney, W., Perez, D., Laderman, M. & Keefe, K., 2009, The Role of Patient Activation on Patient–Provider Communication and Quality of Care for US and Foreign Born Latino Patients, J Gen Intern Med, 24(3), 534–41.
2. Budd, R. J., 1996, The structure of the Readiness to Change Questionnaire: A test of Prochaska & DiClemente’s transtheoretical model, British Journal of Health Pgchology, 1, 365-376.
3. Bandura, A., 1982, Self-efficacy mechanism in human agency, American Psychologist, 37(2),122-47.
4. Begum, N., Donald, M., Ozolins, L. Z. & Dower, J., 2011, Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes, Daibetes Research and Clinical Practice , 93, 260- 267.
5. Champion, V. L., Skinner, C. S., (2008), The Health Belief Model, Glanz K., Rimer B. K., & Viswanath K., In Health Behavior and Health Education Theory, Research and Practice, Wiley Imprent, 4th edition, 45-62.
6. Dağ, İ., 2002, Kontrol Odağı Ölçeği (KOÖ): Ölçek Geliştirme, Güvenirlik ve Geçerlik Çalışması, Türk Psikoloji Dergisi 2002, 17 (49), 77 – 90.
7. Deen, D., Lu, W., Rothstein, D., Santana, L. & Gold, M., 2011, Asking questions: The effect of a brief intervention in community health centers on patient activation, Patient Education and Counseling, 84, 257–260.
8. Dixon, A., Hibbard, J. & Tusler, M., 2009, How do people with different levels of activation self manage their chronic conditions, Patient, 2 (4), 257-268.

9. DiClemente, C.C., 2007, The Transtheorotical Model of İntensional Behavioral Change, Drug and Alcohol today, 7(1), 29-33.
10. Freeman, A., Dolan, M., 2001, Revisiting Prochaska and DiClemente's Stages of Change Theory: An Expansion and Specification to Aid in Treatment Planning and Outcome Evaluation, Cognitive and Behavioral Practice, 8, 224-234.
11. Greene, J, Hibbard, J., 2011, Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes, J Gen Intern Med, 27(5), 520–6.
12. Global Status Report on Noncommunicable Diseases, 2010. Erişim
13. http://whqlibdoc.who.int/publications/2011/9789240686458_ eng.pdf?ua=1, 30.05.2014.
14. Gözüm, S. & Aydın, İ., 2004, Validation Evidence for Turkish Adaptation of Champion’s Health Belief Model Scales, Cancer Nursing, 27( 6), 491-498.
15. Gözüm, S. & Aksayan, S., 1999, Öz etkililik Yeterlik Ölçeğinin Türkçe Formunun Güvenirlik ve Geçerliği, Atatürk Üniv. Hemşirelik Yüksekoukul Dergisi, 2 (1), 21-34.
16. Greenfıeld, S., Kaplan, S. & Ware, J. E., 1985, Expanding Patient Involvement in Care Effects on Patient Outcomes, Annals ol Internal Medicine, 102, 520-528.
17. Hibbard, J. H. & Greene, J., 2013, What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs, Health Affairs, 32(2), 207-214.
18. Hibbard, J. H., Greene, J. & Tusler, M., 2009, Improving the Outcomes of Disease Management by Tailoring Care to the Patient’s Level of Activation, American Journalof managed care, 15(6), 353-360.
19. Hibbard, J.H., Mahoney, E. R, Stock, R. & Tusler, M., 2007, Do Increases in Patient Activation Result in Improved SelfManagement Behaviors, Health Research and Educational Trust, 42(4), 1443-1463.
20. Hibbard, J.H., Mahoney, E. R., Stock, R. & Tusler, M., 2005, Development and Testing of a Short Form of the Patient Activation Measure, HSR: Health Services Research, 40(6), 1918-1930.
21. Hibbard, J.H., Mahoney, E. R, Stock, R. & Tusler, M, 2004, Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers, HSR: Health Services Research, 39(4), 1005- 1026.
22. Horwitz, R.I. & Horwitz, S.M., 1993, Adherence to treatment and health outcomes, Arch Intern Med., 153, 1863–1868.
23. Jerant, A. F., Fitzwater, M. M., F. & Moore, M., 2005, Patients’ perceived barriers to active self-management of chronic conditions, Patient Education and Counseling, 57, 300–307.
24. Jhonson, J. L., Ratner, P. A., Bottorf, J. L. & Hayduk, L. A., 1993, An exploration of Pender' s Health Promotion Model using Lisrel, Nursing Research, 42(3),132-37.
25. Lubetkin, E. I., Marthe, W. L. & Gold, M. R., 2010, Levels and Correlates of Patient Activation in Health Center Settings: Building Strategies for Improving Health Outcomes, Journal of Health Care for the Poor and Underserved 21, 796–808.
26. Lorig, K.R. & Holman, H., 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann. Behav. Med., 26, 1–7.
27. Mitchell, S. E. Et al., 2013, Patient Activation and 30-Day PostDischarge Hospital Utilization, J. Gen. Intern. Med., 29(2), 349–55.
28. Martin, L. T., Schonlau, M., Haas, A., Pitkin, K., Rosenfeld, L. & Buka, S., 2011, Patient Activation and Advocacy: Which Literacy Skills Matter Most?, Journal of Health Communication, 16:177–190.
29. Magnezi, R. & Glasser, S., 2014, Psychometric Properties of the Hebrew Translation ofthe Patient Activation Measure (PAM13), 9(11), 1-6
30. Noncommunicable diseases World Health Association, 2010. Erişim: http://www.who.int/nmh/countries/tur_en.pdf?ua=1, 30.05.2014.
31. Özmen, D. & Özsoy, S., 2009, Sağlık inanç modeli yaklaşımı ile servikal kanserin erken tanısına yönelik tutum ölçeği geliştirilmesi, Ege Üniversitesi Hemşirelik Yüksekokulu Dergisi, 25 (1), 51-69.
32. Palank, C. L.,1991, Determinants of health promotive behavior , Nurs. Clin. North. Am., 26(4), 815-31.
33. Pender, N.J., 1987, Health Promotion in Nursing Practice, 2nd edition, Appleton & Lange, USA, Gözüm, S. & Aksayan, S., 1999, Öz erkililik Yeterlik Ölçeğinin Türkçe Formunun Güvenirlik ve Geçerliği, Atatürk Üniv. Hemşirelik Yüksekoukul Dergisi, 2 (1), 21-34.
34. Rademakers, J., Nijman, J., Hoek, L., Heijmans, M. & Rijken, M., 2012, Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13), BMC Public Health, 12(577), 1-7.
35. Remmers, C., 2008, The Relationship Between the Patient Activation Measure, Future Health Outcomes, and Health Care Utilization Among Patients with Diabetes, Walden University, Baltimore, doctoral dissertation.
36. Rotter J. B., 1966, Generalized expectancies for internal versus external control of reinforcement, Psychological Monographs: General and Applied, 80 (1),1-28.
37. Rosenstock,, I. M., Strecher, V. J., & Becker, M. H., 1988, Social learning theory and the health belief model, Health Education & Behavior, 15(2), 175-183.
38. Sherer, M. et al., 1982, The self-efficacy scale construction and validatian, Psychological Reports, 51,663-71.
39. Cited in Gözüm, S. & Aksayan, S., 1999, Öz erkililik Yeterlik Ölçeğinin Türkçe Formunun Güvenirlik ve Geçerliği, Atatürk Üniv. Hemşirelik Yüksekoukul Dergisi, 2 (1), 21-34.
40. Sürdürülebilir Sağlık Sistemi İçin Kronik Hastalık Yönetiminde Elektronik Sağlık Kayıtlarının Rolü, Tüsiad Sosyal İşler Komisyonu Sağlık Politikaları ve Stratejileri Alt Çalışma Grubu, 2012. Erişim: http://www.tusiad.org.tr/__rsc/shared/file/ErdalAkalin -03072012.pdf, 30.05.14.
41. Strecher, V. J. & Rosenstock, I. M., 1997, Health Belief Model. In Cambridge Handbook of Psychology, Health and Medicine (pp.113- 120). Cambridge Univesity press.
42. Türkiye kronik hastalıklar ve risk faktörleri sıklığı çalışması, TC. Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu, 2013.
43. Erişim:http://www.thsk.saglik.gov.tr/Dosya/kronik_hastali klar/tkh-final-raporu-tr.pdf, 30.05.14.
44. Türkmen, E., 2012, Kronik Hastalıklar ve Önemi, Durna Z., Kronik Hastalıklar ve Bakım, Nobel Tıp Kitabevleri, İstanbul, 37-49.
45. Von Korff, M., Gruman, J., Schaefer, J., Curry, S.J. & Wagner, E.H., 1997, Collaborative Management of Chronic Illness, Annuls of Internal Medicine, 127 (12): 1097-1102.
46. Wagner, E. H., Bennett, S. M., Austın, B. T., Greene, S. M. & Schaefer, J. K., 2005, Finding Common Ground: Patient-Centeredness and Evidence-Based Chronic Illness Care, The Journal Of Alternatıve And Complementary Medıcıne, 11(1): 7-15.
47. Wdowik, M. J., Kendall, P. A., Harris, M. A., & Auld, G., 2001, Expanded health belief model predicts diabetes self-management in college students. Journal of Nursing Education 33, 17-23.