Effectiveness of community-links practitioners in areas of high socioeconomic deprivation
Autor: | Alex McConnachie, Greg James-Rae, Catherine A. O'Donnell, Sally Wyke, Andisheh Bakhshi, Nai Rui Chng, Bridie Fitzpatrick, Lesley Grant, Stewart W Mercer |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Referral Cost-Benefit Analysis Comorbidity Hospital Anxiety and Depression Scale Vulnerable Populations law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Quality of life law Intervention (counseling) medicine Humans 030212 general & internal medicine Healthcare Disparities Socioeconomic status Depression (differential diagnoses) Original Research Aged Community Health Workers Primary Health Care business.industry Middle Aged Scotland Socioeconomic Factors Linear Models Quality of Life Physical therapy Anxiety Female medicine.symptom Family Practice business |
Zdroj: | Ann Fam Med |
ISSN: | 1544-1709 |
Popis: | PURPOSE: To assess the effect of a primary care–based community-links practitioner (CLP) intervention on patients’ quality of life and well-being.\ud \ud METHODS: Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. Primary outcome: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). Secondary outcomes: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked.\ud \ud RESULTS: Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources.\ud \ud CONCLUSIONS: We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach. |
Databáze: | OpenAIRE |
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