Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial
Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial
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DOI：
10.1370/afm.996
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发表时间：
2009-07-01
影响因子：
4.4
通讯作者：
Franks, Peter
中科院分区：
文献类型：
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作者：
Jerant, Anthony;Moore-Hill, Monique;Franks, Peter
目的研究表明，同伴主导的自我管理训练通过提高疾病管理自我效能来改善慢性病的结局。然而，大多数研究的局限性包括使用多个结果测量而没有预先指定的主要结果，以及缺乏超过6个月的随机随访。我们进行了一项为期一年的随机对照试验，归因于健康(HIOH)，这是一种慢性病自我管理计划的变体，以解决这些限制。方法我们随机选择了415名40岁及以上的门诊患者，他们患有一种或多种常见的6种慢性疾病，并有功能障碍，在家中或通过电话或常规护理的HIOH治疗6周。主要结果是医学结果研究36项简明健康调查的身体部分(PCS-36)和精神部分(MCS-36)的总分。次要结果包括EQ-5D和视觉模拟评分(EQ-VAS)、住院和医疗费用。结果与常规护理相比，家庭护理在6周(效果大小=0.27；95%CI，0.10~0.43)和6个月(0.17；95%CI，0.01~0.33)时显著提高疾病管理自我效能感，但在1年时不显著。家庭内HIOH对PCS-36或MCS-36得分没有显著影响，仅导致EQ VAS(1年效应大小=0.40；CI为0.14-0.66)的1个次要结果的改善。电话HIOH对任何结果都没有显著影响。结论尽管与CDSMP研究中的其他研究相比，家庭HIOH在自我效能感方面的改善与其他CDSMP研究相当，但家庭HIOH仅对一项二级健康状况测量产生有限的持续影响，并且对利用率没有影响。这些发现从卫生系统的角度对同伴主导的疾病自我管理培训的成本效益提出了质疑。
PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. Limitations of most studies, however, include use of multiple outcome measures without predesignated primary outcomes and lack of randomized follow-up beyond 6 months. We conducted a 1-year randomized controlled trial of Homing in on Health (HIOH), a Chronic Disease Self-Management Program variant, addressing these limitations.METHODS We randomized outpatients (N = 415) aged 40 years and older and who had I or more of 6 common chronic illnesses, plus functional impairment, to HIOH delivered in homes or by telephone for 6 weeks or to usual care. Primary outcomes were the Medical Outcomes Study 36-Item short-form health survey's physical component (PCS-36) and mental component (MCS-36) summary scores. Secondary outcomes included the EuroQoI EQ-5D and visual analog scale (EQ VAS), hospitalizations, and health care expenditures.RESULTS Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks (effect size = 0.27; 95% CI, 0.10-0.43) and at 6 months (0.17; 95% CI, 0.01-0.33), but not at 1 year. In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome, the EQ VAS (1-year effect size = 0.40; CI, 0.14-0.66). HIOH delivered by telephone had no significant effects on any outcomes.CONCLUSIONS Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies, in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization. These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.