Enablement of older people with chronic disease attending an ambulatory care centre
Foley, Mary J.
University College Cork
Background: Population ageing, and the increasing incidence of chronic disease requires a responsive health service and new enabling models of care (Wren et al. 2017, Bridges et al. 2019, Kennedy 2019). Within the dynamics of healthcare engagement, there is recognition of the positive influence of the enabling skills of the health professional on patient enablement encompassing knowledge, confidence, coping and management of health and illness (Howie et al. 1997, 1998). The clinical consultation is a pivotal exchange between the health professional and patient, so it is vital to optimise its quality (Al Momen et al. 2015, Pawlikowska & Marinowicz, 2015). The Consumer Enablement Model (Batterham et al. 2017) acknowledges the diverse contexts in which people seek care and identifies dynamic determinants and key components (cognitive, affective/motivational, physical, and relational) that impact enablement. Little is known about the factors influencing enablement in an older adult population living with chronic health conditions attending an ambulatory care service. Aim: To examine enablement of older people with chronic disease post consultation with a health professional and identify influencing factors for low enablement. Method: A descriptive quantitative, cross-sectional survey was conducted. Data Collection: Data were collected using a 72-item questionnaire. In addition to demographic questions, it contained the validated instruments Patient Enablement Instrument (PEI) (Howie et al. 1997), Patient Activation Measure (Hibbard et al. 2005) and Clinical Frailty Scale (Rockwood et al. 2005) and modified Physician Enabling Skills Questionnaire (Hudon et al. 2015). Sample: In total, 300 older people with chronic disease were recruited from an ambulatory care centre (attending nurse, doctor, or therapist). Incomplete questionnaires were omitted, leaving a sample of 273 for analysis. Data Analysis: Descriptive and inferential statistical analysis was used. Logistic backward stepwise regression examined the association between the independent variables and the dependent variable low enablement (PEI score ≤ 4). Findings: The study population mean age was 79.7 years (SD 6.8) and 52% were female. Sixty-one per cent of participants had three or more chronic conditions, 35% described their health as fair or poor, and 26% indicated that they were frail (CFS ≥ 5). The population mean PEI score was 4.48 (SD 3.5). In the final multivariate analysis, four variables remained independent predictors of low enablement: female gender (OR 1.96 (CI 1.07- 3.60), clinical frailty (per 1 unit increase) OR 1.26 (95% CI 0.93-1.63), two variables were protective, patient activation OR 0.97 (95% CI 0.95-0.99) and health care professional enabling skills (OR 0.92 (95% CI 0.89-0.94). There were an additional eight variables that were significant in the univariate analysis: older age, living alone, three or more chronic diseases, poor self-reported health, psychological morbidity, receipt of home help, visit from a public health nurse and being seen by a single discipline during the clinic visit. Conclusion: This research affirms that older people have the capacity to become more enabled and are responsive to the enabling skills of the health professional and proactive coordinated multidisciplinary engagement. Enablement post-consultation is multi-faceted, with risk and protective factors that influence individual health gains. Quality measures & expectations of health gains should be viewed within this wider context. Implications for practice: Research findings support a person enablement model that provides for a heterogenous population in a state of transition (health, functional, psychological). Modifiable risk factors associated with low enablement, such as frailty and low patient activation require a comprehensive holistic assessment and bespoke interventions beyond a single consultation. The enabling skills of the health professional are important to optimise patient gains and enhance understanding, management and coping with chronic illness. Healthy ageing strategies reinforced by health professionals committed to making every contact count, supports the political and strategic paradigm shift towards sustaining older people in the community.
Enablement , Consultation , Older people , Chronic disease , Ambulatory care
Foley, M. J. 2020. Enablement of older people with chronic disease attending an ambulatory care centre. PhD Thesis, University College Cork.