Enhancing self-management of multimorbidity in primary care: A randomised controlled trial

Abstract Background: Effective primary care interventions for multimorbidity are needed. Aim: To evaluate the effectiveness of a group-based six-week occupational therapy led self-management support programme (OPTIMAL) for patients with multimorbidity. Design and Setting: A pragmatic parallel randomised trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity. The intervention was OPTIMAL with a usual care comparison. Methods: Primary outcomes were health-related quality of life (EQ5D) and frequency of activity participation (FAI). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/ ≥65 years) and the number of chronic conditions (<4/ ≥4) were explored further. Results: 124 participants (83%) and 121 (81%) participants had complete data at immediate and six-month post-intervention follow-up. Intervention participants had a significant improvement in EQ-VAS at immediate follow-up (Adjusted MD=7.86; 95% CI 0.92 to 14.80) but no difference in the index score (Adjusted MD= 0.04; 95% CI -0.06 to 0.01) or FAI (Adjusted MD = 1.22; 95% CI -0.84 to 3.29). At six-month follow-up there were no differences in primary outcomes. There were mixed results for secondary outcomes. Pre-planned sub-group analyses suggested participants aged <65 years were more likely to benefit. Conclusions: OPTIMAL was not effective in improving health related quality of life or activity participation at six-month follow up. Pre-planned sub-group analyses results suggest that future research should target younger adults (age <65 years) with multimorbidity.

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Effects of the “Living well with COPD” intervention in primary care: a comparative study

European Respiratory Journal ◽

10.1183/13993003.01375-2017 ◽

2018 ◽

Vol 51 (1) ◽

pp. 1701375 ◽

Cited By ~ 12

Author(s):

Claudia Steurer-Stey ◽

Kaba Dalla Lana ◽

Julia Braun ◽

Gerben ter Riet ◽

Milo A. Puhan

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Usual Care ◽

Self Management ◽

Health Related Quality ◽

Management Intervention ◽

Living Well ◽

Related Quality ◽

Health Related

The pivotal objective of chronic obstructive pulmonary disease (COPD) self-management programmes is behaviour change to avoid moderate and severe exacerbations and improve health related quality of life.In a prospectively planned, controlled study, COPD patients who participated in the “Living well with COPD” (LWWCOPD) self-management intervention were compared with usual care patients from the primary care COPD Cohort ICE COLD ERIC, who did not receive self-management intervention (NCT00706602) The primary outcome was behaviour change and disease-specific health related quality of life after 1 year. Secondary end-points included exacerbation rates. We calculated mixed linear, zero-inflated negative binomial and logistic regression models and used propensity scores to counteract confounding.467 patients, 71 from the LWWCOPD and 396 from the usual care cohort, were included. The differences between intervention and control were 0.54 (95% CI 0.13−0.94) on the Chronic Respiratory Questionnaire domain “mastery”, 0.55 (95% CI 0.11−0.99) on “fatigue”, 0.54 (0.14−0.93) on “emotional function” and 0.64 (95% CI 0.14−1.14) on “dyspnoea”. The intervention considerably reduced the risk of moderate and severe exacerbations (incidence rate ratio 0.36, 95% CI 0.25−0.52).Self-management coaching in primary care improves health-related quality of life and lowers exacerbation rates and health care use.

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Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

10.21203/rs.3.rs-28514/v4 ◽

2020 ◽

Author(s):

James John ◽

W Kathy Tannous ◽

Amanda Jones

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Related Quality ◽

Before And After ◽

Related Quality ◽

Health Related ◽

Primary Care Patients ◽

Baseline Covariates

Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

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Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

10.21203/rs.3.rs-28514/v2 ◽

2020 ◽

Author(s):

James John ◽

Kathy Tannous ◽

Amanda Jones

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Statistical Significance ◽

Health Related Quality ◽

Before And After ◽

Related Quality ◽

Health Related ◽

Primary Care Patients

Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol EQ-5D-5L instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Per-protocol (Model 1) and multiple imputation models (Model 2), the latter using a fully conditional specification (FCS) of Markov Chain Monte Carlo (MCMC) algorithm was analysed. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results: Out of 616 patients, 417 (69%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). However, the imputed model failed to meet statistical significance. The multivariable regression models determined that baseline EQ-5D scores, positive diagnosis of a respiratory illness, and private health insurance status were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored CDM plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

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Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

10.21203/rs.3.rs-28514/v3 ◽

2020 ◽

Author(s):

James John ◽

W Kathy Tannous ◽

Amanda Jones

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Related Quality ◽

Before And After ◽

Related Quality ◽

Health Related ◽

Primary Care Patients ◽

Baseline Covariates

Abstract Purpose Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol EQ-5D-5L instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. Conclusion Patient-tailored CDM plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

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Changes in Health-Related Quality of Life Before and After a 12-month Enhanced Primary Care Model Among Chronically Ill Primary Care Patients in Australia.

10.21203/rs.3.rs-28514/v1 ◽

2020 ◽

Author(s):

James John ◽

Kathy Tannous ◽

Amanda Jones

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Statistical Significance ◽

Health Related Quality ◽

Before And After ◽

Related Quality ◽

Health Related ◽

Primary Care Patients

Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices in Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and specially trained chronic disease management (CDM) clinical coordinators (CCs) providing patient-tailored CDM plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol EQ-5D-5L instrument. A case-series study design with repeated measures ANCOVA was used to assess changes in EQ-5D index scores after controlling for baseline covariates. Per-protocol analysis and imputed model, the latter using Markov Chain Monte Carlo (MCMC) algorithm of multiple imputation were analysed. A backward stepwise multivariate linear regression models were conducted to determine predictors of EQ-5D index scores at follow-up. In addition to EQ-5D instrument, a supplementary analysis was carried out with use of the short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOS and HOOS) reported by patients diagnosed with osteoarthritis. Results: Out of 616 patients, 417 (69%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). However, the imputed model failed to meet statistical significance. The multivariate regression models determined that baseline EQ-5D scores, positive diagnosis of a respiratory illness, and private health insurance status were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored CDM plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

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