Are Primary Healthcare Organizational Attributes Associated with Patient Self-Efficacy for Managing Chronic Disease?

• Published in: Healthcare policy Vol. 6; no. 4; pp. e89 - e105
• Main Authors: Lemieux, Valérie, Lévesque, Jean-Frédéric, Ehrmann-Feldman, Debbie
• Format: Journal Article
• Language: English
• Published: Canada Longwoods Publishing 01.05.2011
• Subjects: Chronic sickness; Health status; Online Exclusive; Primary health care; Provinces; Selfefficacy; Selfmanagement
• ISSN: 1715-6572; 1715-6580
• DOI: 10.12927/hcpol.2011.22350

Our objective was to explore how individual and primary healthcare (PHC) organizational attributes influence patients' ability in chronic illness self-management. We conducted a cohort study, recruiting 776 adults with chronic disease from 33 PHC settings in the province of Quebec. Organizational data on the PHC clinics were obtained from a prior study. Participants were interviewed at baseline, 6 and 12 months, responding to questionnaires on self-efficacy, health status, socio-demographics, healthcare use and experience of care. Multilevel modelling showed that 52.5% of the variance in self-efficacy occurs at the level of the individual and 4.0% at the organizational level. Controlling for diagnosis, patient factors associated with self-efficacy were self-rated health (B coeff 0.76: CI 0.60; 0.92), concurrent depression (B coeff -1.41: CI 1.96; -0.86) and satisfaction with care (B coeff 0.27: CI 0.15; 0.39). None of the organizational attributes was significantly associated with self-efficacy after adjusting for lower-level variables. Patients generally reported receiving little self-management teaching across organizations.