Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial

Abstract

PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-effi cacy. Limitations of most studies, however, include use of multiple outcome measures without predesignated primary outcomes and lack of randomized follow-up beyond 6 months. We conducted a 1-year randomized controlled trial of Homing in on Health (HIOH), a Chronic Disease Self-Management Program variant, addressing these limitations. METHODSWe randomized outpatients (N = 415) aged 40 years and older and who had 1 or more of 6 common chronic illnesses, plus functional impairment, to HIOH delivered in homes or by telephone for 6 weeks or to usual care. Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey's physical component (PCS-36) and mental component (MCS-36) summary scores. Secondary outcomes included the EuroQol EQ-5D and visual analog scale (EQ VAS), hospitalizations, and health care expenditures. RESULTSCompared with usual care, HIOH delivered in the home led to significantly higher illness management self-effi cacy at 6 weeks (effect size = 0.27; 95% CI, 0.10-0.43) and at 6 months (0.17; 95% CI, 0.01-0.33), but not at 1 year. In-home HIOH had no signifi cant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome, the EQ VAS (1-year effect size = 0.40; CI, 0.14-0.66). HIOH delivered by telephone had no signifi cant effects on any outcomes.CONCLUSIONS Despite leading to improvements in self-effi cacy comparable to those in other CDSMP studies, in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization. These fi ndings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.

Increasing Access to Chronic Disease Self-Management Programs in Rural and Remote Communities Using Telehealth

“…2 Several randomized controlled trials have shown the CDSMP to be effective in increasing self-efficacy, which in turn has been related to improving health status and health behaviors. [3][4][5][6][7][8][9][10][11][12][13] CDSMPs have an important role in rural and remote areas with limited access to and availability of healthcare and community-based services but have been rarely evaluated in this setting. 14,15 Delivery of the CDSMP via telehealth 16 would address three important barriers: the need for program leaders in every community; the need for leaders to travel long distances to communities, particularly remote areas without leaders; and the need for a sufficient number of participants to form a face-to-face group in each community.…”

In This Issue: Systematic Strategies and Individualized Approaches to Care

“…6 Although the home-based intervention improved self-effi cacy in the short term, there was limited effect on quality of life at 1 year and no effect on utilization. The telephone-based program did not yield signifi cant effects.…”

Response Rates in a Nursing Intervention Longitudinal Study on Vulnerable Elderly Patients

“…Experimental studies examining the effects of educational interventions on quality of life or functional status in elderly people show response rates of 30.9% [5], 59.6% [6], 62.6% [7], 77.1% [8], or 99.6% [9]. However in some studies it is not comprehensible why the authors differentiate between eligible patients and patients fulfilling inclusion criteria.…”

“…Thus the sample sizes are not clear. If the authors reported reasons for nonparticipation these were refusal or decline to participate [5,6,7] or lack of consent [8].…”