Objective: To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions.
Design: Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only.
Setting and participants: Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide.
Main outcome measures: The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation.
Results: 254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13–5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant.
Conclusion: CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education.
Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12609000726257.
- 1. Institute of Medicine Committee on Identifying Priority Areas for Quality Improvement; Adams K, Corrigan JM, editors. Priority areas for national action: transforming health care quality. Washington (DC): National Academies Press (US), 2003. https://www.ncbi.nlm.nih.gov/books/NBK221294/ (viewed May 2017).
- 2. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996; 74: 511-544.
- 3. National Health Priority Action Council. National chronic disease strategy. Canberra: Australian Government Department of Health and Ageing, 2006. http://webarchive.nla.gov.au/gov/20141215061219/http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-ncds-strat (viewed May 2017).
- 4. Zwerink M, Brusse-Keizer M, van der Valk PD, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; (3): CD002990.
- 5. Jordan RE, Majothi S, Heneghan NR, et al. Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis. Health Technol Assess 2015; 19: 1-516.
- 6. Kroon FP, van der Burg LR, Buchbinder R, et al. Self-management education programmes for osteoarthritis. Cochrane Database Syst Rev 2014; (1): CD008963.
- 7. Chodosh J, Morton SC, Mojica W, et al. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 2005; 143: 427-438.
- 8. Kenning C, Coventry PA, Bower P. Self-management interventions in patients with long-term conditions: a structured review of approaches to reporting inclusion, assessment, and outcomes in multimorbidity. J Comorb 2014; 4: 37-45.
- 9. Britt HC, Harrison CM, Miller GC, et al. Prevalence and patterns of multimorbidity in Australia. Med J Aust 2008; 189: 72-77. <MJA full text>
- 10. Smith SM, Soubhi H, Fortin M, et al. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 2012; 345: e5205.
- 11. Reed RL, Battersby M, Osborne RH, et al. Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases. Contemp Clin Trials 2011; 32: 946-952.
- 12. Battersby M, Harvey P, Mills PD, et al. SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care. Milbank Q 2007; 85: 37-67.
- 13. Idler EL, Angel RJ. Self-rated health and mortality in the NHANES-I epidemiologic follow-up study. Am J Public Health 1990; 80: 446-452.
- 14. Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007; 66: 192-201.
- 15. Nolte S, Elsworth GR, Sinclair AJ, et al. The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. Patient Educ Couns 2007; 65: 351-360.
- 16. Bowling A. Just one question: If one question works, why ask several? J Epidemiol Community Health 2005; 59: 342-345.
- 17. Meurer LN, Layde PM, Guse CE. Self-rated health status: a new vital sign for primary care? WMJ 2001; 100: 35-39.
- 18. Fayers PM, Sprangers MA. Understanding self-rated health. Lancet 2002; 359: 187-188.
- 19. Sansoni JE, Grootemaat P, Seraji MH, et al. Targeting integrated care to those most likely to need frequent health care: a review of social and clinical risk factors. Wollongong:: Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, 2015. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/274742/Evidence_Check_Targeting_integrated_care_Social_and_clinical_risk_factors.pdf (viewed May 2017).
- 20. Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions: final report. Canberra: Australian Government Department of Health, 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/primary-phcag-report (accessed May 2017).
- 21. Billot L, Corcoran K, McDonald A, et al. Impact evaluation of a system-wide chronic disease management program on health service utilisation: a propensity-matched cohort study. PLoS Med 2016; 13: e1002035.
- 22. RAND Europe, Ernst & Young LLP. National evaluation of the Department of Health’s integrated care pilots: final report. London: Department of Health; 2012. http://www.rand.org/content/dam/rand/pubs/technical_reports/2012/RAND_TR1164.pdf (accessed May 2017).
- 23. Battersby M, Harris M, Smith D, et al. A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services. Patient Educ Couns 2015; 98: 1367-1375.
- 24. Reed RL, Barton CA, Isherwood LM, et al. Recruitment for a clinical trial of chronic disease self-management for older adults with multimorbidity: a successful approach within general practice. BMC Fam Pract 2013; 14: 125.
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