Article Text

PDF

A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease
  1. A P Kennedy1,
  2. E Nelson1,
  3. D Reeves1,
  4. G Richardson2,
  5. C Roberts3,
  6. A Robinson4,
  7. A E Rogers1,
  8. M Sculpher2,
  9. D G Thompson4,
  10. the North-West Regional Gastrointestinal Research Group
  1. 1National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
  2. 2Centre for Health Economics, University of York, York, UK
  3. 3Biostatistics Group, Epidemiology Research Unit, University of Manchester, Manchester, UK
  4. 4Section of Gastrointestinal Science, University of Manchester, Manchester, UK
  1. Correspondence to:
    Dr A Kennedy
    National Primary Care Research and Development Centre, University of Manchester, Manchester, UK; anne.kennedyman.ac.uk

Abstract

Objectives: We developed a patient centred approach to chronic disease self management by providing information designed to promote patient choice. We then conducted a randomised controlled trial of the approach in inflammatory bowel disease (IBD) to assess whether it could alter clinical outcome and affect health service use.

Design: A multicentre cluster randomised controlled trial.

Setting: The trial was conducted in the outpatient departments of 19 hospitals with randomisation by treatment centre, 10 control sites, and nine intervention sites. For patients at intervention sites, an individual self management plan was negotiated and written information provided.

Participants: A total of 700 patients with established inflammatory bowel disease were recruited.

Main outcome measures: Main outcome measures recorded at one year were: quality of life, health service resource use, and patient satisfaction. Secondary outcomes included measures of enablement—confidence to cope with the condition.

Results: One year following the intervention, self managing patients had made fewer hospital visits (difference −1.04 (95% confidence interval (CI) −1.43 to −0.65); p<0.001) without increase in the number of primary care visits, and quality of life was maintained without evidence of anxiety about the programme. The two groups were similar with respect to satisfaction with consultations. Immediately after the initial consultation, those who had undergone self management training reported greater confidence in being able to cope with their condition (difference 0.90 (95% CI 0.12–1.68); p<0.03).

Conclusions: Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control.

  • IBD, inflammatory bowel disease
  • IBDQ, inflammatory bowel disease questionnaire
  • HADS, hospital anxiety and depression scale
  • PEI, patient enablement instrument
  • ICC, intraclass correlation coefficient
  • DNAs, did not attend for clinic appointment
  • randomised controlled trial
  • inflammatory bowel disease
  • self management

Statistics from Altmetric.com

Footnotes

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.