Introduction
Materials and methods
Study design, setting and participants
Determinant variables
Determinant | Data source |
---|---|
Age Gender | The Hospital Business Intelligence (BI) Register in Central Denmark Region [14] |
Cohabitation status | The Danish Civil Registration Register (CPR) [17] |
Education | The Danish Education Register [18] |
Household income | Danish register on income and transfer payments [19] |
Labour market affiliation | The Danish Register for Evaluation and Marginalisation (DREAM) [20] |
Co-morbidity Psychiatric disease | The Danish National Patient Registry (DNPR) [21] |
Well-being | WHO-Five Well-Being Index (WHO-5) [28] |
General health | |
Health literacy | |
Self-efficacy | |
Patient activation | Patient Activation Measure 13 (PAM-13) [32] |
Register data
Questionnaire data
Outpatient follow-up
Outcome
Statistical analysis
Results
Characteristics of the study population
Total n (%) | Responders n (%) | Non-responders n (%) | |
---|---|---|---|
N = 802 | N = 411 | N = 391 | |
Age, years | |||
15–24 | 168 (21) | 78 (19) | 90 (23) |
25–39 | 136 (17) | 46 (11) | 90 (23) |
40–59 | 187 (23) | 93 (23) | 94 (24) |
60–69 | 124 (15) | 76 (18) | 48 (12) |
70–99 | 187 (23) | 118 (29) | 69 (18) |
Gender | |||
Female | 387 (48) | 204 (50) | 183 (47) |
Male | 415 (52) | 207 (50) | 208 (53) |
Cohabitation status | |||
Not living alone | 492 (61) | 280 (68) | 212 (54) |
Solo living | 290 (36) | 124 (30) | 166 (42) |
Missing | 20 (2) | 7 (2) | 13 (3) |
Education | |||
High (> 12 years) | 135 (17) | 79 (19) | 56 (14) |
Medium (10–12 years) | 281 (35) | 154 (37) | 127 (32) |
Low (< 10 years) | 327 (41) | 154 (37) | 173 (44) |
Missing | 59 (7) | 24 (6) | 35 (9) |
Household incomea | |||
High | 266 (33) | ||
Medium | 267 (33) | ||
Low | 261 (33) | ||
Missing | 8 (1) | ||
Labour market affiliation | |||
Self-supporting | 243 (30) | 132 (32) | 111 (28) |
Normal retirement | 234 (29) | 151 (37) | 83 (21) |
Temporary social benefits | 174 (22) | 69 (17) | 105 (27) |
Permanent social benefits | 151 (19) | 59 (14) | 92 (24) |
Co-morbidity (Charlson index) | |||
Low 0 | 463 (58) | 231 (56) | 232 (59) |
Medium 1–2 | 233 (29) | 122 (30) | 111 (28) |
High > 2 | 106 (13) | 58 (14) | 48 (12) |
Psychiatric disease | |||
No | 703 (88) | 365 (89) | 338 (86) |
Yes | 99 (12) | 46 (11) | 53 (14) |
Total (%) | PRO-based follow-up | Conventional follow-up | End of outpatient care or emigrated | |
---|---|---|---|---|
N = 411 | n = 113 | n = 197 | n = 82 | |
Social support for health (HLQ4) | ||||
Mean (SD) | 3.3 (0.60) | 3.4 (0.49) | 3.2 (0.63) | 3.2 (0.67) |
Median (IQR) | 3.4 (3.0 −3.8) | 3.4 (3.0−3.8) | 3.2 (3.0−3.6) | 3.4 (3.0−3.8) |
Missing, n (%) | 10 (2.4) | |||
Ability to actively engage with healthcare providers (HLQ6) | ||||
Mean (SD) | 3.6 (0.95) | 3.9 (0.83) | 3.5 (0.98) | 3.6 (0.99) |
Median (IQR) | 3.8 (3.0−4.2) | 4.0 (3.4−4.4) | 3.6 (3.0−4.2) | 3.8 (3.1−4.3) |
Missing, n (%) | 9 (2.2) | |||
Understanding health information well enough to know what to do (HLQ9) | ||||
Mean (SD) | 3.6 (0.97) | 3.9 (0.78) | 3.5 (1.02) | 3.7 (0.95) |
Median (IQR) | 3.8 (3.0−4.3) | 4.0 (3.5−4.4) | 3.8 (2.8−4.2) | 4.0 (3.2−4.4) |
Missing, n (%) | 9 (2.2) | |||
Self-efficacy (GSE) | ||||
Mean (SD) | 27.4 (7.4) | 29.0 (5.9) | 26.0 (7.8) | 29.5 (6.6) |
Median (IQR) | 29 (23−33) | 30 (26−32) | 27 (20−32) | 30 (26−34) |
Missing, n (%) | 37 (9.0) | |||
Well-being (WHO-5) | ||||
Mean (SD) | 61.3 (23.9) | 66.8 (21.0) | 56.2 (24.9) | 66.9 (20.4) |
Median (IQR) | 64 (48−80) | 72 (56−80) | 60 (36−76) | 72 (52−80) |
Missing, n (%) | 17 (4.1) | |||
General health, n (%) | ||||
Excellent | 36 (8.8) | |||
Very good | 94 (22.9) | |||
Good | 149 (36.3) | |||
Fair | 86 (20.9) | |||
Poor | 33 (8.0) | |||
Missing | 13 (3.1) | |||
Patient activationb, n (%) | ||||
Disagree strongly | 31 (7.5) | |||
Disagree | 102 (24.8) | |||
Agree | 170 (41.4) | |||
Agree strongly | 94 (22.9) | |||
Missing | 14 (3.4) | |||
Patient activationc, n (%) | ||||
Disagree Strongly | 49 (11.9) | |||
Disagree | 86 (20.9) | |||
Agree | 190 (46.2) | |||
Agree strongly | 74 (18.0) | |||
Missing | 12 (2.9) |
Register determinants of referral to PRO-based follow-up
6-month follow-up | 12-month follow-up | 18-month follow-up | ||||
---|---|---|---|---|---|---|
Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | |
Age, years | ||||||
15–24 | Ref | Ref | Ref | Ref | Ref | Ref |
25–39 | 1.04 (0.63–1.70) | 0.99 (0.57–1.71) | 0.91 (0.59–1.40) | 0.85 (0.54–1.36) | 0.90 (0.59–1.36) | 0.84 (0.54–1.30) |
40–59 | 1.08 (0.68–1.71) | 0.98 (0.58–1.65) | 1.02 (0.69–1.50) | 0.94 (0.60–1.46) | 1.01 (0.70–1.47) | 0.92 (0.60–1.40) |
60–69 | 1.08 (0.65–1.80) | 0.77 (0.43–1.37) | 0.98 (0.63–1.52) | 0.83 (0.50–1.37) | 0.85 (0.55–1.30) | 0.73 (0.45–1.19) |
70–99 | 1.01 (0.64–1.60) | 0.92 (0.52–1.62) | 0.90 (0.60–1.34) | 1.06 (0.62–1.78) | 0.84 (0.57–1.24) | 0.95 (0.58–1.58) |
Gender | ||||||
Female | Ref | Ref | Ref | Ref | Ref | Ref |
Male | 1.32 (0.97–1.80) | 1.35 (0.95–1.92) | 1.29 (0.99–1.69) | 1.28 (0.96–1.69) | 1.39 (1.07–1.81) | 1.36 (1.03–1.79) |
Cohabitation status | ||||||
Living with a partner/family | Ref | Ref | Ref | Ref | Ref | Ref |
Living alone | 0.61 (0.43–0.86) | 0.60 (0.41–0.89) | 0.55 (0.40–0.75) | 0.55 (0.39–0.78) | 0.58 (0.43–0.79) | 0.63 (0.45–0.89) |
Education | ||||||
High (> 12 years) | Ref | Ref | Ref | Ref | Ref | Ref |
Medium (10–12 years) | 1.03 (0.70–1.51) | 0.97 (0.66–1.46) | 1.25 (0.88–1.78) | 1.22 (0.86–1.74) | 1.20 (0.85–1.69) | 1.15 (0.82–1.62) |
Low (< 10 years) | 0.53 (0.34–0.81) | 0.46 (0.28–0.75) | 0.65 (0.44–0.96) | 0.62 (0.41–0.94) | 0.69 (0.47–1.01) | 0.65 (0.44–0.97) |
Household income | ||||||
High | Ref | Ref | Ref | Ref | Ref | Ref |
Medium | 0.46 (0.32–0.67) | 0.61 (0.39–0.94) | 0.52 (0.38–0.71) | 0.69 (0.48–1.00) | 0.50 (0.37–0.68) | 0.64 (0.44–0.93) |
Low | 0.49 (0.34–0.71) | 0.59 (0.38–0.90) | 0.43 (0.30–0.60) | 0.51 (0.35–0.75) | 0.41 (0.29–0.57) | 0.47 (0.32–0.68) |
Labour market affiliation | ||||||
Self-supporting | Ref | Ref | Ref | Ref | Ref | Ref |
Normal retirement | 0.71 (0.49–1.01) | 0.69 (0.42–1.13) | 0.74 (0.54–1.02) | 0.86 (0.55–1.37) | 0.65 (0.48–0.89) | 0.77 (0.49–1.20) |
Temporary social benefits | 0.69 (0.47–1.03) | 0.68 (0.45–1.05) | 0.78 (0.55–1.09) | 0.79 (0.56–1.13) | 0.68 (0.49–0.95) | 0.69 (0.49–0.96) |
Permanent social benefits | 0.38 (0.22–0.67) | 0.55 (0.29–1.04) | 0.44 (0.27–0.71) | 0.60 (0.35–1.02) | 0.39 (0.24–0.62) | 0.51 (0.31–0.84) |
Co-morbidity (Charlson Index) | ||||||
Low 0 | Ref | Ref | Ref | Ref | Ref | Ref |
Medium 1–2 | 0.79 (0.54–1.14) | 0.73 (0.48–1.12) | 0.72 (0.52–1.00) | 0.69 (0.46–0.97) | 0.74 (0.54–1.01) | 0.74 (0.52–1.04) |
High > 2 | 1.09 (0.72–1.66) | 1.08 (0.68–1.71) | 0.88 (0.60–1.29) | 0.89 (0.60–1.33) | 0.78 (0.53–1.14) | 0.82 (0.55–1.23) |
Psychiatric disease | ||||||
No | Ref | Ref | Ref | Ref | Ref | Ref |
Yes | 0.65 (0.37–1.15) | 0.75 (0.42–1.36) | 0.47 (0.26–0.85) | 0.55 (0.30–1.01) | 0.44 (0.24–0.82) | 0.50 (0.27–0.93) |
Questionnaire determinants of referral to PRO-based follow-up
6-month follow-up | 12-month follow-up | 18-month follow-up | ||||
---|---|---|---|---|---|---|
Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | |
Social support for health (HLQ4) | ||||||
High (> 2) | Ref | Ref | Ref | Ref | Ref | Ref |
Low (≤ 2) | 0.47 (0.09–2.44) | 0.43 (0.07–2.48) | 0.43 (0.09–2.02) | 0.40 (0.08–2.06) | 0.38 (0.07–2.02) | 0.40 (0.07–2.20) |
Ability to actively engage with healthcare providers (HLQ6) | ||||||
High (> 3) | Ref | Ref | Ref | Ref | Ref | Ref |
Low (≤ 3) | 0.60 (0.37–0.98) | 0.73 (0.42–1.28) | 0.55 (0.35–0.88) | 0.63 (0.38–1.05) | 0.55 (0.35–0.89) | 0.64 (0.39–1.05) |
Understanding health information well enough to know what to do (HLQ9) | ||||||
High (> 3) | Ref | Ref | Ref | Ref | Ref | Ref |
Low (≤ 3) | 0.42 (0.24–0.75) | 0.53 (0.28–1.01) | 0.41 (0.23–0.71) | 0.48 (0.26–0.87) | 0.40 (0.23–0.69) | 0.45 (0.25–0.82) |
Self-efficacy (GSE) | ||||||
High (≥ 30) | Ref | Ref | Ref | Ref | Ref | Ref |
Low (< 30) | 0.61 (0.42–0.89) | 0.69 (0.46–1.04) | 0.63 (0.46–0.88) | 0.73 (0.52–1.03) | 0.60 (0.43–0.84) | 0.69 (0.49–0.98) |
Well-being (WHO-5) | ||||||
High (≥ 50) | Ref | Ref | Ref | Ref | Ref | Ref |
Low (< 50) | 0.67 (0.43–1.03) | 0.73 (0.45–1.18) | 0.54 (0.36–0.82) | 0.59 (0.38–0.91) | 0.50 (0.33–0.78) | 0.55 (0.35–0.86) |
General health | ||||||
Excellent/very good | Ref | Ref | Ref | Ref | Ref | Ref |
Good | 1.02 (0.67–1.54) | 1.07 (0.69–1.65) | 0.82 (0.56–1.19) | 0.88 (0.60–1.30) | 0.71 (0.50–1.02) | 0.76 (0.52–1.12) |
Fair/poor | 0.61 (0.36–1.02) | 0.72 (0.41–1.25) | 0.47 (0.29–0.75) | 0.57 (0.34–0.94) | 0.38 (0.24–0.61) | 0.46 (0.28–0.76) |
Patient activationb | ||||||
Agree strongly/agree | Ref | Ref | Ref | Ref | Ref | Ref |
Disagree strongly/disagree | 0.55 (0.36–0.86) | 0.64 (0.38–1.07) | 0.57 (0.38–0.85) | 0.65 (0.42–0.99) | 0.51 (0.34–0.76) | 0.57 (0.38–0.88) |
Patient activationc | ||||||
Agree strongly/agree | Ref | Ref | Ref | Ref | Ref | Ref |
Disagree strongly/disagree | 0.54 (0.34–0.86) | 0.58 (0.34–0.97) | 0.56 (0.37–0.86) | 0.59 (0.37–0.93) | 0.50 (0.33–0.76) | 0.54 (0.35–0.83) |
6-month follow-up | 12-month follow-up | 18-month follow-up | ||||
---|---|---|---|---|---|---|
Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | Crude RR | Adjusted RRa | |
Social support for health (HLQ4 score) | 1.40 (1.04–1.87) | 1.35 (0.99–1.87) | 1.38 (1.06–1.80) | 1.31 (1.00–1.72) | 1.49 (1.13–1.97) | 1.40 (1.05–1.87) |
Ability to actively engage with healthcare providers (HLQ6 score) | 1.35 (1.12–1.64) | 1.26 (1.00–1.59) | 1.38 (1.16–1.65) | 1.32 (1.09–1.61) | 1.40 (1.18–1.66) | 1.34 (1.12–1.61) |
Understanding health information well enough to know what to do (HLQ9 score) | 1.39 (1.15–1.67) | 1.30 (1.04–1.63) | 1.35 (1.16–1.57) | 1.30 (1.09–1.54) | 1.40 (1.19–1.65) | 1.36 (1.13–1.62) |
Self-efficacy (GSE score) | 1.03 (1.01–1.05) | 1.02 (0.99–1.05) | 1.03 (1.01–1.05) | 1.02 (0.99–1.04) | 1.03 (1.01–1.06) | 1.03 (1.00–1.05) |
Well-being Index (WHO-5 score) | 1.01 (1.00–1.02) | 1.01 (0.99–1.01) | 1.01 (1.00–1.02) | 1.02 (1.00–1.02) | 1.01 (1.01–1.02) | 1.01 (1.00–1.02) |