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Self management ‘has no effect on outcomes’

Self-management support for patients with chronic conditions has ‘no significant effects’ on patients outcomes or NHS use, claims a UK primary care study.

The study

Researchers randomised 44 general practices in the northwest of England to either an intervention arm - involving staff training and support in enouraging self-management in patients - or a control arm. The study recruited 5,599 patients with long-term conditions such as diabetes and COPD. Practices in the intervention arm were provided with a tool to assess the support needs of patients, self-help guidebooks, access to relevant web-based directory of local community groups and programs as well as access to psychological therapists for patients with irritable bowel syndrome. Patient-level outcomes were collected at baseline, six and 12 months. The primary outcomes at 12 months were shared decision making, self efficacy and generic health related quality of life (EQ-5D).

The findings

At the six-month follow up, 81% of patients were still in the trial and 72.8% completed the 12-month follow up. There were no statistically significant differences between the two groups with similar percentages of intervention and control patients receiving a guidebook (25% vs 24%), and encouragement to use community programmes (19% vs 20%) and patient support groups (115 vs 12%).

What does this mean for GPs?

The authors said that the trial had ‘important implications’ for primary care: ‘An intervention to enhance self management support for patients with chronic conditions in UK primary care had no significant effects on patient outcomes or on service use.

‘Embedding self management support into routine primary care practice cannot be achieved within existing educational structures and may require considerable additional incentives to encourage practices to engage with a self management agenda.’

BMJ 2013, online 13 May


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