TY - JOUR
T1 - Identifying Behavioral Phenotypes in Chronic Illness
T2 - Self-Management of COPD and Comorbid Hypertension
AU - Perez-Benzo, Grace M.
AU - Muellers, Kimberly
AU - Chen, Shiqi
AU - Liu, Bian
AU - Bagiella, Emilia
AU - O'Conor, Rachel
AU - Wolf, Michael S.
AU - Wisnivesky, Juan P.
AU - Federman, Alex D.
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/3
Y1 - 2021/3
N2 - Objectives: To identify and characterize the constellation, or clusters, of self-management behaviors in patients with chronic obstructive pulmonary disease (COPD) and comorbid hypertension. Methods: Cluster analysis (n = 204) was performed with standardized scores for medication adherence to COPD and hypertension medications, inhaler technique, and diet as well as self-reported information on physical activity, appointment keeping, smoking status, and yearly influenza vaccination for a total of eight variables. Classification and regression tree analysis (CART) was performed to further characterize the resulting clusters. Results: Patients were divided into three clusters based on eight self-management behaviors, which included 95 patients in cluster 1, 42 in cluster 2, and 67 in cluster 3. All behaviors except for inhaler technique differed significantly among the three clusters (P's<0.005). CART indicated physical activity was the first differentiating variable. Conclusions: Patients with COPD and hypertensioncan be separated into those with adequate and inadequate adherence. The group with inadequate adherence can further be divided into those with poor adherence to medical behaviors compared to those with poor adherence to lifestyle behaviors. Practice Implications: Once validated in other populations, the identification of patient clusters using patient self-management behaviors could be used to inform interventions for patients with multimorbidity.
AB - Objectives: To identify and characterize the constellation, or clusters, of self-management behaviors in patients with chronic obstructive pulmonary disease (COPD) and comorbid hypertension. Methods: Cluster analysis (n = 204) was performed with standardized scores for medication adherence to COPD and hypertension medications, inhaler technique, and diet as well as self-reported information on physical activity, appointment keeping, smoking status, and yearly influenza vaccination for a total of eight variables. Classification and regression tree analysis (CART) was performed to further characterize the resulting clusters. Results: Patients were divided into three clusters based on eight self-management behaviors, which included 95 patients in cluster 1, 42 in cluster 2, and 67 in cluster 3. All behaviors except for inhaler technique differed significantly among the three clusters (P's<0.005). CART indicated physical activity was the first differentiating variable. Conclusions: Patients with COPD and hypertensioncan be separated into those with adequate and inadequate adherence. The group with inadequate adherence can further be divided into those with poor adherence to medical behaviors compared to those with poor adherence to lifestyle behaviors. Practice Implications: Once validated in other populations, the identification of patient clusters using patient self-management behaviors could be used to inform interventions for patients with multimorbidity.
KW - Chronic Obstructive Pulmonary Disease
KW - Cluster Analysis
KW - Comorbidities
KW - Self-Management Behaviors
UR - http://www.scopus.com/inward/record.url?scp=85090562516&partnerID=8YFLogxK
U2 - 10.1016/j.pec.2020.08.025
DO - 10.1016/j.pec.2020.08.025
M3 - Article
C2 - 32921518
AN - SCOPUS:85090562516
SN - 0738-3991
VL - 104
SP - 627
EP - 633
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 3
ER -