Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3067 — Self-Management Learning Needs of Veterans with Multimorbidity

Author List:
Noel PH (VERDICT-South Texas Veterans Health Care System/UTHSCSA)
Parchman ML (VERDICT-South Texas Veterans Health Care System/UTHSCSA)
Zeber J (VERDICT-South Texas Veterans Health Care System/UTHSCSA)
Lee S (VERDICT-South Texas Veterans Health Care System/UTHSCSA)
Pugh JA (VERDICT-South Texas Veterans Health Care System/UTHSCSA)

Objectives:
The Chronic Care Model suggests that optimal care is advanced with informed, activated patients supported by a continuum of self-management training services. Because investigations of patient self-management have been largely disease-specific, we used a cross-sectional survey to explore self-management learning needs of veterans with multiple chronic illnesses, or multimorbidity.

Methods:
We extracted diagnoses for inpatient and outpatient encounters over a 3-year period for primary care patients (N=23,038) at a single VAMC. Patients were stratified into 3 multimorbidity clusters previously demonstrated to be highly prevalent among veterans, and 3 patient groups with a single chronic illness from the corresponding cluster. We then used non-proportional sampling to randomly select 120 patients from each group for a total of 720 patients. A mailed survey of collaborative care needs included the Self-Management Learning Needs (SMLN) questionnaire, reflecting 22 self-management skills for chronic illness identified by expert panel and through focus groups of veterans with multimorbidity. Patients used a 5-point rating scale indicating their desire to learn each self-management skill (“4=would definitely want to learn” to “0=would definitely not want to learn”). A principal component factor analysis indicated a 1-factor solution; Cronbach’s coefficient alpha=0.94.

Results:
Non-parametric analyses indicated that the self-management learning needs of the multimorbidity patients were significantly higher than those of single disease patients (3.14 vs. 2.9; p=0.0043). Multimorbidity patients compared to single disease patients indicated a greater desire to learn all 22 self-management skills; 12 of these were significant: monitor important symptoms, use medications correctly, lose weight, question doctor effectively, use resources in community, adjust to physical limitations, manage emotional reactions, manage pain, develop hobbies, improve sexual relationship, take care of spiritual needs, and stop smoking. Robust regression indicated that multimorbidity was significantly associated (p=0.02) with an increased desired for learning these 12 self-management skills after controlling for age, gender, ethnicity, educational level, and functional status (F= 3.27;prob>F=0.002).

Implications:
Self-management learning needs of veterans with multimorbidity are more extensive than those of patients with single chronic illness.

Impacts:
A tool such as the SMLN questionnaire may help patients and their providers collaboratively identify and prioritize self-management learning needs and chronic illness care goals.