The Gerontologist Advance Access originally published online on July 8, 2009
The Gerontologist 2009 49(6):778-792; doi:10.1093/geront/gnp090
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Patient Satisfaction, Empowerment, and Health and Disability Status Effects of a Disease Management–Health Promotion Nurse Intervention Among Medicare Beneficiaries With Disabilities
2 Department of Community and Preventive Medicine, University of Rochester, New York
3 Department of Psychiatry, University of Rochester, New York
4 Department of Social Work, West Virginia State University
5 School of Nursing, University of Rochester, New York
6 Department of Statistics, University of Wyoming, Laramie
7 Monroe County Long Term Care Program, Inc. (ACCESS), Rochester, New York
1 Address correspondence to Bruce Friedman, PhD, MPH, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642. E-mail: bruce_friedman{at}urmc.rochester.edu
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Abstract |
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Purpose: To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care–affiliated disease self-management–health promotion nurse intervention for Medicare beneficiaries with disabilities and recent significant health services use. Design and Methods: The Medicare Primary and Consumer-Directed Care Demonstration was a 24-month randomized controlled trial that included a nurse intervention. The present study (N = 766) compares the nurse (n = 382) and control (n = 384) groups. Generalized linear models for repeated measures, linear regression, and ordered logit regression were used. Results: The patients whose activities of daily living (ADL) were reported by the same respondent at baseline and 22 months following baseline had significantly fewer dependencies at 22 months than did the control group (p = .038). This constituted the vast majority of respondents. In addition, patient satisfaction significantly improved for 6 of 7 domains, whereas caregiver satisfaction improved for 2 of 8 domains. However, the intervention had no effect on empowerment, self-rated health, the SF-36 physical and mental health summary scores, and the number of dependencies in instrumental ADL. Implication: If confirmed in other studies, this intervention holds the potential to reduce the rate of functional decline and improve satisfaction for Medicare beneficiaries with ADL dependence.
Keywords: Self-efficacy, Health locus of control, Self-rated health status, SF-36, ADL, IADL, Primary care, Home care
Received September 25, 2008; Accepted March 16, 2009