ArticleThe Impact of Primary Care patients' Pain and Emotional Problems on Their Confidence With Self-ManagementWasson, John H. MD; Johnson, Deborah J. BS; Mackenzie, Todd PhDAuthor Information From the Dartmouth Medical School, Hanover, NH. Corresponding author: John H. Wasson, MD, 35 Centerra Parkway Suite 300, Lebanon, NH 03766 (e-mail: [email protected]). This research was supported by a grant from The Robert Wood Johnson Foundation. We thank the following participating physician groups: Barre Internal Medicine (Bruce Talmadge, MD; Marvin Malek, MD; Priscilla Carr, MD; Amy Brewer, MD; Kathleen Jackman, MD; Linda Parks); Evergreen Family Health (Paul Reiss, MD; James Dougherty, MD; Jan Ferris, DO; Molly Backup, PA-C; Nancy Resi, FNP); Hacker and Meess (Peter Hacker, MD); Miles Medical Group – Waldoboro (Walter Love, MD; Margaret Webb, MD; John Dickens, MD; Jennifer Oddleifson, PA-C; Phyllis Buchanan, PA-C; Sheila Irving); Montpelier Health Center (Michael Rapaport, MD; Marilyn Nelson, MD; Laurie Hulsman, MD; Rebecca Scholl, PA-C; Debra Maloney-Evans, NP; Linda Parks); Mount Washington Valley Healthcare Association, Inc. (M. Angus Badger, MD; Krystie Karageorge, MD; Raymond Rabideau, MD; David Riss, MD; Chandrakumer Singarayer, MD; Diane Snow, MD; Patti Duprey, ARNP; Gale, Johnsen, ARNP; Dan Dyer, Carolyn Roosenboom, Karen Estey, Leona Kelly); New Ipswich Family Medicine (John Haley, MD); Redington Medical Associates (Roger Renfrew, MD; Donna Conkling, MD; Oto Prokop, MD; David Prokop, MD; Gina Gomez, MD); Robert A. Mesropian Center for Community Care (Peter Mason, MD; Eric Bronstein, MD; Brian Lombardo, MD; Doug Williamson, MD; Larry Lancaster, PA; Carol Williams-Suich, ARNP; Krista Merrihew, RN); White River Family Practice (Michael Lyons, MD; Mark Nunlist, MD; Thomas Parrott, MD; Angela Toms, MD; Julie Davis, MD; Peter Loescher, MD; Nancy Arnold, RN, FNP; Kristin Pekala, PA; Joanne Arey; Laurie Needham; Jocelyn Dole; Roberta Stormann; Beverly Martin; Lisa Janowski; Terry Beeman; Tracey Richardson; Elizabeth Romano); Thomas Evans, MD (Barbara Evans, NP; Lisa Sherman, RN; Judy Barlow; Debbie Miller; Dottie Turner); Michael Garcia, MD (Kris Costa; Diane Becker; Robert Mitchell; Mary Ellen Sly); John Kaminski, MD (AnnMarie); Curtis Smith, MD; Anthony Williams, MD (Lori McLellan). Special thanks to Judy Knapp, Research Assistant, Dartmouth-Northern New England COOP Project, for data organization and data entry in support of the study. Journal of Ambulatory Care Management: April 2008 - Volume 31 - Issue 2 - p 120-127 doi: 10.1097/01.JAC.0000314702.57665.a0 Buy Metrics Abstract There is a paucity of information about confidence with self-management in primary care practice. This study examines changes over time in patient-reported confidence with self-management on the basis of 1047 patients aged 50–69 who had common chronic diseases, bothersome pain, or emotional problems. We examined the relationship between patients' self-reported confidence, their experiences of medical care, and health outcomes after adjustment for baseline characteristics. We observed that, over a 2-year period, about a third of the patients remained confident and a third remained not confident. Change in pain or emotional problems was strongly associated with whether a patient was confident or not at the end of the follow-up period (P < .001). Persistently good confidence or improved confidence was strongly associated with measures of high-quality medical care. For patients with diabetes, persistent confidence was more often associated with control of blood glucose (P = .004) compared with the control in patients who were not as confident. Confident patients were likely to be fully engaged in everyday work and activities (P < .001). The results suggest that for the majority of patients in primary care practices, the status of their self-reported confidence with self-management persists over time. Their confidence is impacted by their pain or emotional state and strongly associated with their medical care experiences and some outcomes of care. © 2008 Lippincott Williams & Wilkins, Inc.