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Randomized Controlled Trial
. 2013 May 13:346:f2882.
doi: 10.1136/bmj.f2882.

Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial

Anne Kennedy  1 , Peter Bower, David Reeves, Tom Blakeman, Robert Bowen, Carolyn Chew-Graham, Martin Eden, Catherine Fullwood, Hannah Gaffney, Caroline Gardner, Victoria Lee, Rebecca Morris, Joanne Protheroe, Gerry Richardson, Caroline Sanders, Angela Swallow, David Thompson, Anne Rogers; Salford National Institute for Health Research Gastrointestinal programme Grant Research Group
Affiliations
Randomized Controlled Trial

Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial

Anne Kennedy et al. BMJ. .

Abstract

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of practices through trial
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Fig 2 Forest plot of standardised effect sizes by outcome measure, with vertical bars indicating minimally important differences
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