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Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial.

Blakeman T, Blickem C, Kennedy A, Reeves D, Bower P, Gaffney H, Gardner C, Lee V, Jariwala P, Dawson S, Mossabir R, Brooks H, Richardson G, Spackman E, Vassilev I, Chew-Graham C, Rogers A - PLoS ONE (2014)

Bottom Line: Patients did not differ significantly in positive and active engagement in life.The intervention group reported a reduction in costs compared with control.An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care.

View Article: PubMed Central - PubMed

Affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.

ABSTRACT

Background: Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.

Methods and findings: In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.

Conclusions: An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.

Trial registration: Controlled-Trials.com ISRCTN45433299.

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Related in: MedlinePlus

Trial CONSORT Diagram.
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pone-0109135-g001: Trial CONSORT Diagram.

Mentions: Figure 1 presents the trial CONSORT diagram. 34 practices were initially approached and 10 practices declined to participate in the trial prior to data collection. 440 patients were recruited from 24 GP practices (mean list size; 5815 patients) with an average of 18 patients per practice. Subsequently, 4 patients were excluded post-randomisation because they were identified as not meeting the criteria of having stage 3 CKD. Their registered GPs and the patients were informed. In total, 436 patients completed baseline data and 374 (85.7%) patients returned 6 month follow up data. We excluded two baseline blood pressure readings taken more than 15 months prior to randomisation; all other blood pressure readings were within 6 months of the target dates, with an average deviation of minus 27 days at baseline and minus 17 days at 6 month follow up.


Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial.

Blakeman T, Blickem C, Kennedy A, Reeves D, Bower P, Gaffney H, Gardner C, Lee V, Jariwala P, Dawson S, Mossabir R, Brooks H, Richardson G, Spackman E, Vassilev I, Chew-Graham C, Rogers A - PLoS ONE (2014)

Trial CONSORT Diagram.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199782&req=5

pone-0109135-g001: Trial CONSORT Diagram.
Mentions: Figure 1 presents the trial CONSORT diagram. 34 practices were initially approached and 10 practices declined to participate in the trial prior to data collection. 440 patients were recruited from 24 GP practices (mean list size; 5815 patients) with an average of 18 patients per practice. Subsequently, 4 patients were excluded post-randomisation because they were identified as not meeting the criteria of having stage 3 CKD. Their registered GPs and the patients were informed. In total, 436 patients completed baseline data and 374 (85.7%) patients returned 6 month follow up data. We excluded two baseline blood pressure readings taken more than 15 months prior to randomisation; all other blood pressure readings were within 6 months of the target dates, with an average deviation of minus 27 days at baseline and minus 17 days at 6 month follow up.

Bottom Line: Patients did not differ significantly in positive and active engagement in life.The intervention group reported a reduction in costs compared with control.An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care.

View Article: PubMed Central - PubMed

Affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.

ABSTRACT

Background: Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.

Methods and findings: In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.

Conclusions: An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.

Trial registration: Controlled-Trials.com ISRCTN45433299.

Show MeSH
Related in: MedlinePlus