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Integration of chronic disease prevention and management services into primary care: a pragmatic randomized
Martin Fortin1, Maud-Christine Chouinard1, Marie-France Dubois1
1Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué.
Background:
Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors.
Methods:
We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours.
Results:
Three hundred thirty-two patients were recruited and randomly assigned (n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary (p = 0.017) and the Single Index (p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes.
Interpretation:
It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.
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