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A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial

Richard L Reed, Leigh Roeger, Sara Howard, Jodie M Oliver-Baxter, Malcolm W Battersby, Malcolm Bond and Richard H Osborne
Med J Aust 2018; 208 (2): 69-74. || doi: 10.5694/mja17.00127

Abstract

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.

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  • Richard L Reed1
  • Leigh Roeger1
  • Sara Howard1
  • Jodie M Oliver-Baxter1
  • Malcolm W Battersby1,2
  • Malcolm Bond1
  • Richard H Osborne3

  • 1 Flinders University, Adelaide, SA
  • 2 Flinders Human Behaviour and Health Services Unit, Flinders University, Adelaide, SA
  • 3 Health System Improvement Unit, Centre for Population Health Research, Deakin University, Geelong, VIC


Acknowledgements: 

This investigation was supported by a grant to Flinders University from the Australian Department of Health and Ageing (DoHA) under the Sharing Health Care Initiative – Innovations in Chronic Disease Self-Management Research Grants program. The DoHA had no role in the study design, collection, analysis, and interpretation of data, writing of the article, or the decision to submit it for publication. We thank the patients and general practitioners from Chandlers Hill, Flagstaff Hill and Colonel Light Gardens, and Chris Moschou for their support. We also thank members of the research team for their contributions: the Flinders Program adviser (Vee Pols), Flinders Program clinicians (Angela Eastwood, Katrina Reschke, Melissa Day, Pauline Kelly), attention control group health professionals (Lauren Bullivant, Marie Iannos), our research nurse (Bridgit McAteer-Carr), and the qualitative researchers (Chris Barton, Linda Isherwood, Stacey Masters). Richard Osborne was supported in part by a National Health and Medical Research Council Population Health Research Fellowship (Career Development Award).

Competing interests:

Malcom Battersby is the developer of the Flinders Program. He has no financial interest in the Flinders Program, but Flinders University has received funding from government, commercial and charitable sponsors for the research, development and dissemination of the Flinders Program.

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