Patient characteristics as predictors of sleep disturbances in multimorbid primary care patients - A secondary analysis.

OBJECTIVE: The aim of the study was to identify patient characteristics (adult attachment, health status, number and severity of chronic conditions, social support) predictive sleep disturbances after 12 months. METHODS: In a secondary analysis of a prospective longitudinal study dealing with adult attachment and self-management, attachment- and health-related characteristics, socio-demographic data at baseline and symptoms of insomnia at the follow up (12 month later) was recorded by 219 patients between the ages of 50 and 85 years with multimorbidity in primary care. Adult attachment was measured by the ECR-RD12. The overall health status was measured using a visual analogue scale (VAS) and a standardized list of chronic conditions. The number and severity of chronic diseases (CIRS-G) was assessed by general practitioners (GPs). Sleep disturbances was measured by the ISI 12 month later. RESULTS: Approximately 19% of the respondents were found to have clinically relevant symptoms of insomnia, and a further 34% to be subclinical insomnia. Attachment-related anxiety, a poorer perceived social support, the number of chronic conditions and a better general health status could predict higher levels of sleep disturbance after 12 month. CONCLUSION: Sleep disorders can play a major role in patients with multimorbidity. Attachment anxiety and lack of social support may also be possible risk factors for the development of sleep disturbances.

[The Influence of Attachment Characteristics and Disease-Specific Predictors on Health-Related Quality of Life in Elderly Patients with Multimorbidity]. / Der Einfluss von Bindungsmerkmalen und erkrankungsspezifischen Prädiktoren auf die gesundheitsbezogene Lebensqualität von älteren Patienten und Patientinnen mit Multimorbidität.

OBJECTIVE: Our aim was to further investigate factors influencing multimorbid primary care patients in relation to mental and physical quality of life. METHODS: 219 elderly patients over 50 years with multiple chronic conditions were assessed for quality of life, attachment, depression, and health status at baseline and follow-up after 12 months. Multivariate analyses were performed to identify potential predictors. RESULTS: Depression, age, and avoidance had a negative influence, and health a positive influence, on physical quality of life. Mental quality of life was negatively influenced by attachment-related anxiety and depression. Relevant predictors that predicted quality of life in one year were health status, depression, and attachment-related anxiety. CONCLUSION: To maintain quality of life, mental health and attachment needs of multimorbid patients should be considered.

Evaluation of the short form of "Experience in Close Relationships" (Revised, German Version "ECR-RD12") - A tool to measure adult attachment in primary care.

Attachment theory helps us to understand patients´ health behavior. Attachment styles might explain patient differences in coping behavior, self-treatment, or patient-provider relationships. In primary care time constrains are relevant. A short instrument may facilitate screening and assessment in daily medical practice. The aim of this study was to evaluate a 12-item short version of the Experience in Close Relationships-revised (ECR-R-D) to be used in primary care settings. We included 249 patients from ten general practices in central Germany into a cross-sectional study. Exploratory factor analysis was performed to evaluate the factor structure of the ECR-items. Cronbach's alpha was used to assess internal consistency. The results related to the short form of the ECR are in line with those of the German full-length version of the measure (ECR-RD 36). Internal consistencies were in an adequate range. The ECR short form can be recommended as a screening measure of attachment styles in primary care.

Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

OBJECTIVE: The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. METHOD: 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. RESULTS: The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. CONCLUSION: A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients.

The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care.

OBJECTIVE: Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions. METHODS: In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients' GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management. RESULTS: 219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use. CONCLUSION: The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.

Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients.

The patients' active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D) in German-speaking primary care patients. This international cross-sectional multicentre study enrolled consecutively patients from primary care practices in three German-speaking countries: Germany, Austria, and Switzerland. Patients completed the PAM13-D questionnaire. General Self-Efficacy scale (GSE) was used to assess convergent validity. Furthermore Cronbach's alpha was performed to assess internal consistency. Exploratory factor analysis was used to evaluate the underlying factor structure of the items. We included 508 patients from 16 primary care practices in the final analysis. Results were internally consistent, with a Cronbach's alpha of 0.84. Factor analysis revealed one major underlying factor. The mean values of the PAM13-D correlated significantly (r = 0.43) with those of the GSE. The German PAM13 is a reliable and valid measure of patient activation. Thus, it may be useful in primary care clinical practice and research.