TY - JOUR 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 DO - 10.3399/bjgp21X714293 SP - bjgp21X714293 AU - Moira Stewart AU - Martin Fortin AU - Judith Belle Brown AU - Bridget L Ryan AU - Pauline Pariser AU - Jocelyn Charles AU - Thuy-Nga Pham AU - Pauline Boeckxstaens AU - Sonja M Reichert AU - Guangyong Zou AU - Onil Bhattacharyya AU - Alan Katz AU - Helena Piccinini-Vallis AU - Tara Sampalli AU - Sabrina Wong AU - Merrick Zwarenstein Y1 - 2020/12/11 UR - http://bjgp.org/content/early/2020/12/13/bjgp21X714293.abstract N2 - 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. ER -