The objective of this research was to determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care. It was a cluster randomised controlled trial, set in general practices, serving a population in northwest England with high levels of deprivation. 5599 patients with a diagnosis of diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome took part from 43 practices.
Practice level training in a whole systems approach to self management support was undertaken. 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.
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.
44 practices and 5599 patients were randomised, 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.
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.
A Kennedy, P Bower, D Reeves,Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial. BMJ 2013;346:f2882