Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial
| Autor: | Cynthia M. Boyd, Joachim Szecsenyi, Matthias Gondan, Martin Beyer, Jochen Gensichen, Frank Peters-Klimm, Tobias Freund, Cornelia Mahler, Antje Erler, Justine Rochon, Ferdinand M. Gerlach |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Population Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Disease cluster law.invention Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Ambulatory care Randomized controlled trial Risk Factors law Germany Internal Medicine medicine Humans 030212 general & internal medicine education Aged Quality of Health Care Heart Failure Patient Care Team education.field_of_study Self-management Primary Health Care business.industry 030503 health policy & services General Medicine Hospitalization Self Care Physician Assistants Diabetes Mellitus Type 2 Quartile Relative risk Chronic Disease Costs and Cost Analysis Quality of Life Physical therapy Female 0305 other medical science business |
| Zdroj: | Annals of Internal Medicine C.2, 164, 323-30 Annals of Internal Medicine C.2, 164, 5, pp. 323-30 |
| ISSN: | 0003-4819 |
| Popis: | Item does not contain fulltext BACKGROUND: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. OBJECTIVE: To determine whether protocol-based care management delivered by medical assistants improves care in patients at high risk for future hospitalization in primary care. DESIGN: Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508). SETTING: 115 primary care practices in Germany. PATIENTS: 2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data. INTERVENTION: Protocol-based care management, including structured assessment, action planning, and monitoring delivered by medical assistants, compared with usual care. MEASUREMENTS: All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]). RESULTS: Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month. LIMITATION: Small number of primary care practices and low intensity of intervention. CONCLUSION: This low-intensity intervention did not reduce all-cause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients. PRIMARY FUNDING SOURCE: AOK Baden-Wurttemberg and AOK Bundesverband. |
| Databáze: | OpenAIRE |
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