Hospital admissions, emergency department utilisation and patient activation for self-management among people with diabetes

Aims: To assess the relationship between patient activation for self-management and admissions to hospital or attendances at emergency departments among people with diabetes, after controlling for other known associations.

Methods: Patients were randomly selected from Australia's National Diabetes Services Scheme and invited to participate in the Living with Diabetes Study, which is a longitudinal survey providing a comprehensive examination of health care utilisation, well-being and disease progression. Data was collected for 3951 participants.

Results: Outcome events were defined as 1 or more hospitalization and 1 or more visits to an emergency department in the preceding 12 months. Logistic regression analyses showed six variables remained significantly associated with both outcomes: age, income, disease duration and severity, current depression and PAM stage. Patients at PAM stage 1 were 1.4 times more likely to be hospitalised (p=0.023) and 1.3 times more likely to have visited emergency (p=0.049) compared to those at stage 4.

Conclusions: Low levels of activation are associated with higher utilisation of hospital resources even after controlling for relevant factors such as disease severity and co-morbid depression. Most will be gained by moving patients from PAM stage 1 to a higher level of activation.