{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T06:06:49Z","timestamp":1783922809297,"version":"3.55.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,12,22]],"date-time":"2018-12-22T00:00:00Z","timestamp":1545436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30DK034987"],"award-info":[{"award-number":["P30DK034987"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one\u2019s care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn\u2019s disease or ulcerative colitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29\u20130.36) and depression (aOR, 0.33; 95% CI, 0.29\u20130.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20\u20132.45).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ibd\/izy378","type":"journal-article","created":{"date-parts":[[2018,12,22]],"date-time":"2018-12-22T04:28:14Z","timestamp":1545452894000},"page":"1248-1254","source":"Crossref","is-referenced-by-count":30,"title":["High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease"],"prefix":"10.1093","volume":"25","author":[{"given":"Edward L","family":"Barnes","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Millie D","family":"Long","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Kappelman","sequence":"additional","affiliation":[{"name":"Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher F","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S","family":"Sandler","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,22]]},"reference":[{"key":"2020010210003928000_CIT0001","first-page":"s2","article-title":"The challenge of compliance and persistence: focus on ulcerative colitis","volume":"14","author":"Kane","year":"2008","journal-title":"J Manag Care Pharm."},{"key":"2020010210003928000_CIT0002","doi-asserted-by":"crossref","first-page":"947","DOI":"10.2147\/PPA.S133222","article-title":"Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs","volume":"11","author":"Lofland","year":"2017","journal-title":"Patient Prefer Adherence."},{"key":"2020010210003928000_CIT0003","first-page":"859","article-title":"Impact of a patient support program on patient adherence to adalimumab and direct medical costs in Crohn\u2019s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, and ankylosing spondylitis","volume":"23","author":"Rubin","year":"2017","journal-title":"J Manag Care Spec Pharm."},{"key":"2020010210003928000_CIT0004","doi-asserted-by":"crossref","first-page":"2975","DOI":"10.1097\/MIB.0000000000000575","article-title":"Increasing patient activation could improve outcomes for patients with inflammatory bowel disease","volume":"21","author":"Shah","year":"2015","journal-title":"Inflamm Bowel Dis."},{"key":"2020010210003928000_CIT0005","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/j.1475-6773.2004.00269.x","article-title":"Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers","volume":"39","author":"Hibbard","year":"2004","journal-title":"Health Serv Res."},{"key":"2020010210003928000_CIT0006","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1377\/hlthaff.2012.1061","article-title":"What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs","volume":"32","author":"Hibbard","year":"2013","journal-title":"Health Aff (Millwood)."},{"key":"2020010210003928000_CIT0007","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1007\/s11606-011-1931-2","article-title":"Why does patient activation matter? 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