A multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on results

Éric Contant, Christine Loignon, Tarek Bouhali, José Almirall, Martin Fortin, Éric Contant, Christine Loignon, Tarek Bouhali, José Almirall, Martin Fortin

Abstract

Background: Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results.

Methods: Secondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions.

Results: Participants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16-3.55), Emotional well-being (1.97; 1.05-3.68), Self-monitoring and insight (2.35; 1.02-5.40), Constructive attitudes and approaches (2.91; 1.45-5.84), Skill and technique acquisition (1.96; 1.13-3.39), and Health services navigation (2.52; 1.21-5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight.

Conclusions: The intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results.

Trial registration: ClinicalTrials.gov Identifier: NCT01319656.

Keywords: Multimorbidity; Primary care; Self-management; Socioeconomic factors.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval (2010–044) was obtained from the Research Ethics Board of the Centre de santé et de services sociaux de Chicoutimi, Quebec, Canada. Consent to participate was obtained by writing from each participant.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the study

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