The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial
The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial
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DOI：
10.1136/jech.2006.053538
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发表时间：
2007-03-01
影响因子：
6.3
通讯作者：
Rogers, Anne
中科院分区：
文献类型：
--
作者：
Kennedy, Anne;Reeves, David;Rogers, Anne
目的：支持患者的自我护理可能对长期疾病的管理产生重大影响，这导致了全世界对有效自我护理干预的兴趣。在英格兰，当局正透过“专家病人计划”发展自我照顾支援服务，该计划提供由非专业人士主导的一般课程，以改善病人的自我照顾技能。然而，这种课程的临床和成本效益仍不清楚。方法：双臂务实的随机对照试验设计，在英国社区设置的等候名单控制。研究了629名患有各种自定义长期疾病的患者。由外行领导的自我护理支持小组涉及6周一次的课程，教授自我护理技能。主要结果是自我效能，报告的能源和常规卫生服务利用率在6个月。成本效益分析也carried.Results：患者接受即时课程访问报告更大的自我效能感和能源在6个月的后续行动，但在同一时期的常规卫生服务利用率没有统计学显着减少。成本效益分析表明，接受即时治疗的患者报告了更高的健康相关生活质量，并小幅降低了成本。如果质量调整生命年的价值为20 000英镑，（$39 191; EURO 30 282），有70%的概率，干预是成本效益。结论：以非专业人士为主导的自我护理支持小组可以有效地提高长期患病患者的自我效能和能量水平，并且在决策者愿意支付的常规值下，在6个月内可能是成本有效的。它们可能是对目前长期疾病管理服务的有益补充。
Objective: Supporting patients' self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective self care interventions. In England, self care support is being developed through the "Expert Patients Programme", which provides lay-led generic courses to improve patients' self care skills. However, the clinical and cost effectiveness of such courses remains unclear.Methods: Two-arm pragmatic randomised controlled trial design with waiting list control in community settings in England. 629 patients with a wide range of self-defined long-term conditions were studied. The lay-led self care support group involved 6-weekly sessions to teach self care skills. Primary outcomes were self-efficacy, reported energy and routine health services utilisation at 6 months. A cost-effectiveness analysis was also conducted.Results: Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up, but reported no statistically significant reductions in routine health services utilisation over the same time period. The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life, and a small reduction in costs. If a quality adjusted life year was valued at POUNDS20 000 ($ 39 191; EURO30 282), there was a 70% probability that the intervention was cost effective.Conclusions: Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions, and are likely to be cost effective over 6 months at conventional values of a decision-maker's willingness to pay. They may be a useful addition to current services in the management of long-term conditions.