Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial.
Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial.
复制标题
在常规初级保健设置中对长期条件的自我管理支持实施：群集随机对照试验。
DOI：
10.1136/bmj.f2882
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发表时间：
2013-05-13
期刊：
影响因子：
--
通讯作者：
Salford National Institute for Health Research Gastrointestinal programme Grant Research Group
中科院分区：
文献类型：
--
作者：
Kennedy A;Bower P;Reeves D;Blakeman T;Bowen R;Chew-Graham C;Eden M;Fullwood C;Gaffney H;Gardner C;Lee V;Morris R;Protheroe J;Richardson G;Sanders C;Swallow A;Thompson D;Rogers A;Salford National Institute for Health Research Gastrointestinal programme Grant Research Group
目的确定干预措施的有效性，以加强自我管理支持的慢性病患者在英国的初级保健。设计实用，两个手臂，集群随机对照试验。设置一般的做法，服务于英格兰西北部的人口与高度贫困。参与者5599例诊断为糖尿病（n=2546），慢性阻塞性肺疾病（n=1634）和肠易激综合征（n=1419）的43个实践（19个干预和22个对照实践）。干预实践水平的培训，在整个系统的方法，以自我管理的支持。培训实践使用一系列资源：评估患者支持需求的工具，自我管理指南，以及基于网络的本地自我管理资源目录。健康管理组织雇用了培训促进者。主要结果测量主要结果是在12个月时测量的共同决策、自我效能和一般健康相关生活质量。次要结果是一般健康，社会或角色限制，能量和活力，心理健康，自我护理活动和实现。结果我们随机分配了44个诊所，招募了5599名患者，占诊所名单上合格人群的43%。4533例患者（81.0%）完成了6个月随访，4076例（72.8%）完成了12个月随访。参加培训实践的患者和参加对照实践的患者在任何主要或次要结局方面均无统计学显著差异。所有效应量估计值均远低于临床重要差异的预定阈值。结论：在常规初级保健中加强自我管理支持的干预措施并没有为现有的长期护理增加明显的价值。有效的自我管理支持所需的积极成分需要更好地理解，无论是在初级保健和患者的日常生活。试验注册当前对照试验ISRCTN90940049。
Objective To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care. Design Pragmatic, two arm, cluster randomised controlled trial. Setting General practices, serving a population in northwest England with high levels of deprivation. Participants 5599 patients with a diagnosis of diabetes (n=2546), chronic obstructive pulmonary disease (n=1634), and irritable bowel syndrome (n=1419) from 43 practices (19 intervention and 22 control practices). Intervention Practice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were employed by the health management organisation. Main outcome measures Primary outcomes were shared decision making, self efficacy, and generic health related quality of life measured at 12 months. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity, and enablement. Results We randomised 44 practices and recruited 5599 patients, representing 43% of the eligible population on the practice lists. 4533 patients (81.0%) completed the six month follow-up and 4076 (72.8%) the 12 month follow-up. No statistically significant differences were found between patients attending trained practices and those attending control practices on any of the primary or secondary outcomes. All effect size estimates were well below the prespecified threshold of clinically important difference. Conclusions An intervention to enhance self management support in routine primary care did not add noticeable value to existing care for long term conditions. The active components required for effective self management support need to be better understood, both within primary care and in patients’ everyday lives. Trial registration Current Controlled Trials ISRCTN90940049.
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影响因子：
6.3
作者：
Kennedy, Anne;Reeves, David;Rogers, Anne
通讯作者：
Rogers, Anne
影响因子：
2.2
作者：
Goodyear-Smith, Felicity;York, Deon;Grant, Cameron
通讯作者：
Grant, Cameron
影响因子：
2.4
作者：
Kennedy, A;Robinson, A;Wilkin, D
通讯作者：
Wilkin, D
影响因子：
158.5
作者：
Doran, Tim;Fullwood, Catherine;Roland, Martin
通讯作者：
Roland, Martin
影响因子：
3
作者：
Lorig, KR;Sobel, DS;Holman, HR
通讯作者：
Holman, HR