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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.However, further research is required to identify the mechanisms of action of the intervention.

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

Health related quality of life for intervention and control patients.
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pone-0109135-g003: Health related quality of life for intervention and control patients.

Mentions: Figure 2 depicts the unadjusted rates of blood pressure control for the two groups, across time. The rate of control remained stable in the intervention group over the 6 months, but dropped very considerably in control patients, suggesting that the effect of the intervention was to help patients maintain, but not increase, blood pressure control. Mean systolic and diastolic blood pressure in intervention patients changed very little over the 6 months (from 131.6 to 131.5 and 73.6 to 73.4 respectively), but increased in control patients (129.0 to 135.2 and 73.4 to 74.5 respectively). For health related quality of life however, there was an increase in mean score for intervention patients, compared to no change in the control group mean (Figure 3).


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)

Health related quality of life for intervention and control patients.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0109135-g003: Health related quality of life for intervention and control patients.
Mentions: Figure 2 depicts the unadjusted rates of blood pressure control for the two groups, across time. The rate of control remained stable in the intervention group over the 6 months, but dropped very considerably in control patients, suggesting that the effect of the intervention was to help patients maintain, but not increase, blood pressure control. Mean systolic and diastolic blood pressure in intervention patients changed very little over the 6 months (from 131.6 to 131.5 and 73.6 to 73.4 respectively), but increased in control patients (129.0 to 135.2 and 73.4 to 74.5 respectively). For health related quality of life however, there was an increase in mean score for intervention patients, compared to no change in the control group mean (Figure 3).

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.However, further research is required to identify the mechanisms of action of the intervention.

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