Background: Chronic disease management involves Patient Empowerment, Patient Engagement and Patient Activation that enhance patients’ capacity to manage their own health and to collaborate with health professionals for creating personalized health plans and shared decision-making process.

Objectives: The aim of this study was to evaluate the relations among patient empowerment, patient engagement, patient activation and clinical manifestations in pSS.

Methods: This cross-sectional study included 116 pSS patients (F/M:111/5; 53.78±12.30 years) diagnosed according to the 2016 ACR/EULAR pSS diagnostic criteria. Data were collected by clinical examinations and a questionnaire including patient-reported outcome measures (PROMs) and level of knowledge about the disease status. The Patient Empowerment, Engagement and Activation Scale (PEEAS) (Stichler ve Pelletier, 2019), the 5-level EQ-5D and Work Productivity and Activity Impairment (WPAI) as PROMs were used in the study.

PEEAS is a composite scale and high scores in its subgroups reflect better outcomes (Stichler ve Pelletier, 2019). The second PROM was the 5-level EQ-5D version (EQ-5D-5L) that comprises general health status and five dimensions regarding Mobility, Self-care, Usual activities, Pain/discomfort and Anxiety/depression. Finally, the WPAI scale assesses productivity loss and daily activity impairment. WPAI-Activity impairment subgroup was used because limited number of patients were employee in the group. After performing preliminary analyses, simple Mediation analysis was performed.

Results: When the level of knowledge about the disease status was assessed by using the questionnaire, patients who though “Enough information about their health status” (n=84) had elevated scores of Patient Empowerment (27.78±3.49 vs. 23.50±5.00), Patient Engagement (27.59±3.50 vs. 23.75±5.12) and Patient Activation (25.94±5.67 vs. 18.71±6.84) than the others (n=32) (p<0.001). Increases in scores of Patient Empowerment, Patient Engagement and Patient Activation were observed in patients who “Searched about their disease before visiting their physicians” (n=69) (28.21±3.24; 28.05±3.21; 26.39±5.56; respectively) compared to those of others (n=46) (24.26±4.84; 24.06±4.92; 20.23±6.96, respectively) (p<0.001).

Patient activation score was significantly lower in patients with comorbidities (n=98) (23.10±7.03) than that of patients without comorbidities (n=18) (27.16±5.13) (p<0.001). Decrease in scores of Patient Empowerment, Patient Engagement and Patient Activation were significantly associated with older age, low education years, long disease duration, impaired general health status and poor scores of Mobility, Self-care and Pain/discomfort items in EQ-5D5L scale and Activity impairment in WPAI scale (p<0.05). In addition, treatment protocols including steroids (30mg daily dose) (n=6; 29.83±1.72; 29.84±1.70; 29.66±1.36) or Methotrexate (n=8; 28.75±0.70; 28.75±0.71; 27.62±2.72, respectively) were found to have increased scores of Patient Empowerment, Patient Engagement and Patient Activation (26.45±3.72; 26.50±3.73; 21.77±7.61 and 26.29±4.89; 26.12±4.93; 23.44±7.29, respectively) (p<0.05).

According to 3 simple Mediation analyses, General Health status as dependent variable was directly mediated by WPAI-Activity impairment as independent variable in each Mediation analyses (p<0.05). In these models, Patient Empowerment, Patient Engagement and Patient Activation were found to be mediator variables, separately (p<0.05).

The Cronbach-alpha coefficients for internal reliability were 0.824 for Patient Empowerment,

0.816 for Patient Engagement and 0.885 for Patient Activation in PEEAS.

Conclusion: Since both disease-related conditions, personal factors and treatments were associated with Patient Empowerment, Patient Engagement and Patient Activation, individual strategies should be developed by using these clues for better clinical outcomes in patients with pSS.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.