Primary Care Research Group, Community Based Medicine, University of Manchester, 5th Floor Williamson Building, Oxford Road, Manchester M13 9PL, UK.
Implement Sci. 2012 Jan 26;7:7. doi: 10.1186/1748-5908-7-7.
Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care.
The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial.
If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population.
ISRCTN: ISRCTN90940049.
长期病患者越来越成为医疗服务质量改进活动的关注焦点，以减轻这些疾病对生活质量的影响，并减轻对护理利用的负担。人们对自我管理支持在改善这些患者群体的健康和减少利用方面的潜力非常感兴趣，但对于提供这种支持的最佳模式，尚未达成共识。我们描述了通过涉及患者支持、初级保健团队培训和服务重新组织的循证“全系统”模型来实施和评估自我管理支持，所有这些都整合到初级保健的常规服务中。
这项自我管理支持模式的实施、效果和成本效益评估采用了一项多站点大规模的群组随机对照试验，涉及三种长期疾病的患者：糖尿病、慢性阻塞性肺疾病（COPD）和肠易激综合征（IBS）。研究结果包括医疗保健利用和生活质量。我们描述了群组随机试验的方法。
如果“全系统”模式被证明是有效和具有成本效益的，它将为决策者提供一种针对长期病患者群体提供自我管理支持的模式，可以广泛实施，以最大限度地覆盖更广泛的患者群体。
ISRCTN: ISRCTN90940049。
