RT Journal Article
SR Electronic
T1 Patient-Centred Innovation for Multimorbidity Care: Mixed-methods, Randomized Trial and Qualitative Study of the Patients’ Experience
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP bjgp21X714293
DO 10.3399/bjgp21X714293
A1 Stewart, Moira
A1 Fortin, Martin
A1 Brown, Judith Belle
A1 Ryan, Bridget L
A1 Pariser, Pauline
A1 Charles, Jocelyn
A1 Pham, Thuy-Nga
A1 Boeckxstaens, Pauline
A1 Reichert, Sonja M
A1 Zou, Guangyong
A1 Bhattacharyya, Onil
A1 Katz, Alan
A1 Piccinini-Vallis, Helena
A1 Sampalli, Tara
A1 Wong, Sabrina
A1 Zwarenstein, Merrick
YR 2020
UL http://bjgp.org/content/early/2020/12/13/bjgp21X714293.abstract
AB Background: Patient-centered interventions to help patients with multimorbidity have had mixed results. Aim: Assess the effectiveness of a provider-created patient-centred multi-provider case conference with follow-up; understand under what circumstances it worked. Design and Setting: Mixed-methods design with a pragmatic randomized trial and qualitative study, 9 primary care sites, Ontario, Canada. Method: Patients, 18 to 80 years with three plus chronic conditions, were referred to the Telemedicine IMPACT Plus intervention; a nurse and patient planned a multi-provider case conference creating a care plan. The patients were randomized into intervention or control group. Two subgroup analyses and a fidelity assessment were conducted. Primary outcomes, at four months, were: Self-management; Self-efficacy. Secondary outcomes were: Mental and Physical Health status; Quality of life; Health behaviors. A thematic analysis explored the patients' experiences of the intervention. Results: 86 patients in the intervention group and 77 in the control group showed no differences except the intervention was effective for mental health status in the subgroup having an income of equal to or greater than $50K CAD (Beta Coefficient=11.003, p=0.006). More providers and follow-up hours were associated with poorer outcomes. Five qualitative themes were: valuing the team; feeling supported; receiving a follow-up plan; being offered new and helpful additions to their treatment regimen; and experiencing positive outcomes. Conclusions: There was no effect of the intervention overall, except for the patients with $50K CAD or greater income, implying a need to address the costs of uncovered intervention components. Findings suggest a need to optimize team composition and follow-up.