National Institute for Health Research School for Primary Care Research, Health Sciences Research Group, University of Manchester, UK.
Patient Educ Couns. 2012 Apr;87(1):67-73. doi: 10.1016/j.pec.2011.06.007. Epub 2011 Jul 20.
Patients accessing the chronic disease self-management programme (CDSMP) often report multiple long-term conditions (multimorbidity). Although multimorbidity often predicts poor outcomes, CDSMP effectiveness may be enhanced in multimorbidity via synergies between self-management for different conditions. This study assessed whether CDSMP benefits varied by patterns of multimorbidity.
The study was based on a secondary analysis of an RCT. Patients with long-term conditions (n=629) were randomised to CDSMP or wait-list and completed baseline and 6 month assessments. We identified four multimorbidity groups: (1) single physical condition; (2) multiple physical conditions; (3) single physical condition plus 'probable depression'; (4) multiple physical conditions plus 'probable depression'.
Multimorbidity group significantly moderated the effect of CDSMP on vitality, health-related quality of life, and mental well-being, with the greatest benefit found for patients with multiple physical conditions plus 'probable depression'.
The coexistence of depression and multiple physical conditions is associated with increased illness burden, but such patients benefit more from the CDSMP. The mechanisms underlying this effect are unclear, but it does not appear to be through self-management or self-efficacy.
The presence of multimorbidity in combination with depression may be a useful criteria for referral to the CDSMP.
参与慢性病自我管理计划（CDSMP）的患者通常报告存在多种长期疾病（多种合并症）。尽管多种合并症通常预示着不良结局，但 CDSMP 通过不同疾病的自我管理之间的协同作用，可能会增强对多种合并症的效果。本研究评估了 CDSMP 的益处是否因多种合并症的模式而异。
本研究基于一项 RCT 的二次分析。纳入患有长期疾病的患者（n=629），随机分配至 CDSMP 组或候补名单组，并在基线和 6 个月时进行评估。我们确定了四种多种合并症组：（1）单一身体状况；（2）多种身体状况；（3）单一身体状况加“可能的抑郁”；（4）多种身体状况加“可能的抑郁”。
多种合并症组显著调节了 CDSMP 对活力、健康相关生活质量和心理健康的影响，患有多种身体状况加“可能的抑郁”的患者获益最大。
抑郁和多种身体状况的共存与疾病负担的增加有关，但此类患者从 CDSMP 中获益更多。这种效果的机制尚不清楚，但似乎不是通过自我管理或自我效能。
多种合并症加上抑郁的存在可能是将患者转介至 CDSMP 的有用标准。
