Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

Abstract

Background: Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors.

Methods: We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours.

Results: Three hundred thirty-two patients were recruited and randomly assigned (n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary (p = 0.017) and the Single Index (p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes.

Interpretation: It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1

Flow diagram for the PR1MaC study. PR1MaC = Adaptation, implantation et évaluation d'une intervention d'intégration des services de réadaptation en maladies chroniques aux soins de 1re ligne (Adapting and integrating chronic disease prevention and management services into primary care settings), RCT = randomized controlled trial.

Figure 2

Relative risks (RRs) (intervention group v. control group) and 95% confidence intervals (CIs) of a reliable improvement at 3 months compared with baseline, by domain of self-management. Values greater than 1.0 indicate more patients in the intervention group had reliable improvement in a domain of self-management compared with the control group. The difference between the 2 groups is significant when the value of no difference (RR = 1.0) is not included in the CI.

Figure 3

Distribution of changes (improvement or no improvement) in the intervention group after 1 year compared with baseline, by domain of self-management. Values inside the bars show absolute numbers of patients.