Home-based, peer-led chronic illness self-management training

Findings from a 1-year randomized controlled trial

Anthony F Jerant, Monique Moore-Hill, Peter Franks

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

PURPOSE: Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. 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. METHODS: We 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. RESULTS: Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy 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 significant 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 significant effects on any outcomes. CONCLUSIONS: Despite leading to improvements in self-efficacy 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 findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.

Original languageEnglish (US)
Pages (from-to)319-327
Number of pages9
JournalAnnals of Family Medicine
Volume7
Issue number4
DOIs
StatePublished - Jul 2009

Fingerprint

Self Care
Chronic Disease
Randomized Controlled Trials
Health
Self Efficacy
Visual Analog Scale
Telephone
Outcome Assessment (Health Care)
Disease Management
Health Expenditures
Health Surveys
Health Status
Cost-Benefit Analysis
Hospitalization
Outpatients
Delivery of Health Care

Keywords

  • Chronic disease
  • Chronic disease self-management program
  • Health status
  • Qualitative research
  • Randomized controlled trial
  • Self care
  • Self-efficacy

ASJC Scopus subject areas

  • Family Practice

Cite this

Home-based, peer-led chronic illness self-management training : Findings from a 1-year randomized controlled trial. / Jerant, Anthony F; Moore-Hill, Monique; Franks, Peter.

In: Annals of Family Medicine, Vol. 7, No. 4, 07.2009, p. 319-327.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. 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. METHODS: We 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. RESULTS: Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy 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 significant 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 significant effects on any outcomes. CONCLUSIONS: Despite leading to improvements in self-efficacy 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 findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.",
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