Effectiveness of personalised support for self-management in primary care: a cluster randomised controlled trial

• Published in: British journal of general practice 2016-05, Vol.66 (646), p.e354-e361
• Main Authors: Eikelenboom, Nathalie, van Lieshout, Jan, Jacobs, Annelies, Verhulst, Frank, Lacroix, Joyca, van Halteren, Aart, Klomp, Maarten, Smeele, Ivo, Wensing, Michel
• Format: Article
• Language: English
• Subjects: Chronic Disease - therapy; Clinical Protocols; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Male; Netherlands - epidemiology; Precision Medicine; Primary Health Care - methods; Risk Reduction Behavior; Self Care; Social Support; Surveys and Questionnaires
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/bjgp16X684985

Self-management support is an important component of the clinical management of many chronic conditions. The validated Self-Management Screening questionnaire (SeMaS) assesses individual characteristics that influence a patient's ability to self-manage. To assess the effect of providing personalised self-management support in clinical practice on patients' activation and health-related behaviours. A cluster randomised controlled trial was conducted in 15 primary care group practices in the south of the Netherlands. After attending a dedicated self-management support training session, practice nurses in the intervention arm discussed the results of SeMaS with the patient at baseline, and tailored the self-management support. Participants completed a 13-item Patient Activation Measure (PAM-13) and validated lifestyle questionnaires at baseline and after 6 months. Data, including individual care plans, referrals to self-management interventions, self-monitoring, and healthcare use, were extracted from patients' medical records. Multilevel multiple regression was used to assess the effect on outcomes. The PAM-13 score did not differ significantly between the control (n = 348) and intervention (n = 296) arms at 6 months. In the intervention arm, 29.4% of the patients performed self-monitoring, versus 15.2% in the control arm (effect size r = 0.9, P = 0.01). In the per protocol analysis (control n = 348; intervention n = 136), the effect of the intervention was significant on the number of individual care plans (effect size r = 1.3, P = 0.04) and on self-monitoring (effect size r = 1.0, P = 0.01). This study showed that discussing SeMaS and offering tailored support did not affect patient activation or lifestyle, but did stimulate patients to self-monitor and use individual care plans.