Patient-centred innovation for multimorbidity care: a mixed-methods, randomised trial and qualitative study of the patients’ experience
| Autor: | Martin Fortin, Merrick Zwarenstein, Sonja M. Reichert, Bridget L. Ryan, Judith Belle Brown, Pauline Pariser, Onil Bhattacharya, Alan Katz, Helena Piccinini-Vallis, Thuy-Nga Pham, Moira Stewart, Sabrina T. Wong, Jocelyn Charles, Guangyong Zou, Pauline Boeckxstaens, Tara Sampalli |
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| Rok vydání: | 2020 |
| Předmět: |
Canada
medicine.medical_specialty Telemedicine multimorbidity vmultimorbidity Psychological intervention Patient-centred care 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Intervention (counseling) Medicine and Health Sciences medicine Humans Mixed-methods research 030212 general & internal medicine Qualitative Research Primary health care Team composition CONSTRUCTION business.industry Research 030503 health policy & services Multimethodology Multimorbidity Mental health mixed-methods research primary health care patient-centred care Family medicine Chronic Disease Family practice Quality of Life vHEALTH-CARE Thematic analysis 0305 other medical science Family Practice business |
| Zdroj: | Family Medicine Publications BRITISH JOURNAL OF GENERAL PRACTICE The British Journal of General Practice |
| ISSN: | 1478-5242 0960-1643 |
| DOI: | 10.3399/bjgp21x714293 |
| Popis: | BackgroundPatient-centred interventions to help patients with multimorbidity have had mixed results.AimTo assess the effectiveness of a provider-created, patient-centred, multi-provider case conference with follow-up, and understand under what circumstances it worked, and did not work.Design and settingMixed-methods design with a pragmatic randomised trial and qualitative study, involving nine urban primary care sites in Ontario, Canada.MethodPatients aged 18–80 years with ≥3 chronic conditions were referred to the Telemedicine IMPACT Plus intervention; a nurse and patient planned a multi-provider case conference during which a care plan could be created. The patients were randomised into an intervention or control group. Two subgroup analyses and a fidelity assessment were conducted, with the primary outcomes at 4 months being self-management and self-efficacy. Secondary outcomes were mental and physical health status, quality of life, and health behaviours. A thematic analysis explored the patients’ experiences of the intervention.ResultsA total of 86 patients in the intervention group and 77 in the control group showed no differences, except that the intervention improved mental health status in the subgroup with an annual income of ≥C$50 000 (β-coefficient 11.003, P = 0.006). More providers and follow-up hours were associated with poorer outcomes. Five themes were identified in the qualitative study: valuing the team, patients feeling supported, receiving a follow-up plan, being offered new and helpful additions to their treatment regimen, and experiencing positive outcomes.ConclusionOverall, the intervention showed improvements only for patients who had an annual income of ≥C$50 000, implying a need to address the costs of intervention components not covered by existing health policies. Findings suggest a need to optimise team composition by revising the number and type of providers according to patient preferences and to enhance the hours of nurse follow-up to better support the patient in carrying out the case conference’s recommendations. |
| Databáze: | OpenAIRE |
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