Lessons learned implementing and managing the DIVERT-CARE trial: practice recommendations for a community-based chronic disease self-management model

Abstract

Background Chronic disease management models of care provide an opportunity to assist home care clients to manage their disease burden. However, pragmatic trial management practices and lessons learned from such models are poorly illustrated in the literature. Methods We describe the processes of implementing a community-based cardiorespiratory self-management model, known as DIVERT-CARE, across the home care programs of three health regions in Canada. The DIVERT-CARE model is a multi-component complex intervention that identifies home care clients at the highest risk of deterioration and provides them with resources and capacity to manage their conditions. We conducted a retrospective analysis of baseline participant characteristics, needs assessments, reviewed findings from site visits and a national workshop with study partners, and examined other study documentation. Results Three home care regions in Canada participated in the study. A robust and data-driven review of each site was necessary to understand the local context, home care caseloads, structure of local systems, and intensity of resources, which influenced study processes. The creation of an intervention framework highlighted the need to adapt the intervention in a way that was sensitive to the local context while maintaining intervention outcomes. Conclusion Our detailed review showcases the relevant activities and on-the-ground steps needed to manage and conduct a multi-site pragmatic trial in home care. This example can help other researchers in implementing multi-disciplinary and multi-component care models for practice-based research.

Comparison of attitudes toward the medical student-led community health education service to support chronic disease self-management among students, faculty and patients

“…Among the comprehensive management strategies for chronic diseases, the effective daily self-management support has been accepted as one of essential components for high-quality chronic disease management [ 10 ]. Chronic disease self-management approaches included a package of behavioural interventions addressing the medical, physical, emotional, social and related challenges posed by the chronic diseases, aiming to improve health-related attitude and quality of life, as well as to reduce chronic disease-related complications and mortality.…”

Application of family-involved smart medication management system in rural-dwelling middle-aged and older adult participants with chronic diseases: Management of chronic diseases in rural areas

“…[ 3 ] In clinical practice, most patients with chronic diseases require long-term therapeutic pharmacological interventions or lifelong management. [ 4 ] It is essential for patients to strictly adhere to all instructions concerning their medications, as prescribed by their doctor, and not arbitrarily change the medication type and dosage. At present, the medication management system for chronic diseases in China is not without flaws, and relevant guidelines for safe medication management in patients with chronic diseases have not been formulated.…”