Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study

Nina Tusa, Hannu Kautiainen, Pia Elfving, Sanna Sinikallio, Pekka Mäntyselkä, Nina Tusa, Hannu Kautiainen, Pia Elfving, Sanna Sinikallio, Pekka Mäntyselkä

Abstract

Backround: Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension.

Methods: The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017-2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up.

Results: A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes.

Conclusions: During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline.

Trial registration: ClinicalTrials.gov Identifier: NCT02992431 . Registered 14/12/2016.

Keywords: Ageing population; Care plan; Chronic diseases; Impact; Patient care planning; Primary health care; Treatment plan.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow Diagram of the study
Fig. 2
Fig. 2
The participatory care plan process. The process steps are preparation (A), goal setting (B), action planning (C), documenting (D), coordinating (E), supporting (F) and reviewing (G)
Fig. 3
Fig. 3
Effect sizes (Cohen’s d) were calculated to determine the magnitude of the difference between the means of the three disease groups in health-related quality of life (15D), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), Hemoglobin A1c (HbA1C), mean arterial pressure (MAP) and overall. Effect sizes of 0.20, 0.50 and 0.80 were considered small, medium, and large, respectively. Adjusted for baseline value

References

    1. Mittler JN, Martsolf GR, Telenko SJ, Scanlon DP. Making sense of "consumer engagement" initiatives to improve health and health care: a conceptual framework to guide policy and practice. Milbank Q. 2013;91(1):37–77. doi: 10.1111/milq.12002.
    1. Informed Medical Decisions Foundation. Available at: . Accessed 11 Sept 2019.
    1. Young CE, Boyle FM, Mutch AJ. Are care plans suitable for the management of multiple conditions? J Comorb. 2016;6(2):103–113. doi: 10.15256/joc.2016.6.79.
    1. Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PLoS One. 2019;14(8):e0220116. doi: 10.1371/journal.pone.0220116.
    1. WHO Ageing and Life Course. Available at: . Accessed 27 Aug 2019.
    1. Statistics Finland. Tilastokeskus, väestöennuste. Available at: . Accessed 27 Apr 2020.
    1. European Commission Public Health. Available at: . Accessed 11 2019.
    1. Komulainen J, Vuokko R, Mäkelä M. Structured health and care plan. Tampere: Terveyden- ja hyvnvoinnin laitos; 2011.
    1. Coulter A, Roberts S, Dixon A. Delivering better services for people with long-term conditions: building the house of care. London: King's Fund; 2013.
    1. Morgan MA, Coates MJ, Dunbar JA. Using care plans to better manage multimorbidity. Australas Med J. 2015;8(6):208–215. doi: 10.4066/AMJ.2015.2377.
    1. Jansen DL, Heijmans M, Rijken M. Individual care plans for chronically ill patients within primary care in the Netherlands: dissemination and associations with patient characteristics and patient-perceived quality of care. Scand J Prim Health Care. 2015;33(2):100–106. doi: 10.3109/02813432.2015.1030167.
    1. Mikkola I, Hagnas M, Hartsenko J, Kaila M, Winell K. A personalized care plan is positively associated with better clinical outcomes in the Care of Patients with Type 2 diabetes: a cross-sectional real-life study. Can J Diabetes. 2020;44(2):133–8. 10.1016/j.jcjd.2019.05.003.
    1. Burt J, Roland M, Paddison C, Reeves D, Campbell J, Abel G, Bower P. Prevalence and benefits of care plans and care planning for people with long-term conditions in England. J Health Serv Res Policy. 2012;17(1):64–71. doi: 10.1258/jhsrp.2011.010172.
    1. Reeves D, Hann M, Rick J, Rowe K, Small N, Burt J, et al. Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study. Br J Gen Pract. 2014;64(626):568. doi: 10.3399/bjgp14X681385.
    1. Patel MR, Valerio MA, Janevic MR, Gong ZM, Sanders G, Thomas LJ, Clark NM. Long-term effects of negotiated treatment plans on self-management behaviors and satisfaction with care among women with asthma. J Asthma. 2013;50(1):82–89. doi: 10.3109/02770903.2012.743151.
    1. Vuohijoki A, Mikkola I, Jokelainen J, Keinänen-Kiukaanniemi S, Winell K, Frittitta L, et al. Implementation of a personalized care plan for patients with type 2 diabetes is associated with improvements in clinical outcomes: an observational real-world study. J Prim Care Community Health. 2020;11:2150132720921700. doi: 10.1177/2150132720921700.
    1. Oksman E, Sisso M, Kuronen R. Väli-Suomen POTKU-hankkeen loppuraportti 2010–2012. 2013.
    1. Morgan MA, Coates MJ, Dunbar JA, Reddy P, Schlicht K, Fuller J. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open. 2013;3(1). 10.1136/bmjopen-002171.
    1. Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev. 2015;2015(3):CD010523. 10.1002/14651858.CD010523.pub2.
    1. Saarni SI, Härkänen T, Sintonen H, Suvisaari J, Koskinen S, Aromaa A, Lönnqvist J. The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D. Qual Life Res. 2006;15(8):1403–1414. doi: 10.1007/s11136-006-0020-1.
    1. Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the patient-reported outcomes measurement information system (PROMIS) J Clin Epidemiol. 2010;63(11):1195–1204. doi: 10.1016/j.jclinepi.2010.04.012.
    1. Samiei Siboni F, Alimoradi Z, Atashi V, Alipour M, Khatooni M. Quality of life in different chronic diseases and its related factors. Int J Prev Med. 2019;10:65. doi: 10.4103/ijpvm.IJPVM_429_17.
    1. Cepeda-Valery B, Cheong AP, Lee A, Yan BP. Measuring health related quality of life in coronary heart disease: the importance of feeling well. Int J Cardiol. 2011;149(1):4–9. doi: 10.1016/j.ijcard.2010.09.048.
    1. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ. 2017;356:j84. doi: 10.1136/bmj.j84.
    1. Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8(6):e021161. doi: 10.1136/bmjopen-2017-021161.
    1. Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600–e611. doi: 10.3399/bjgp20X712289.
    1. Gray DP, Sideway-Lee K, White E, Thorne A, Evans P. Improving continuity: THE clinical challenge. InnovAiT. 2016;9(10):635–645. doi: 10.1177/1755738016654504.
    1. Raivio R, Jääskeläinen J, Holmberg-Marttila D, Mattila KJ. Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care - a 14-year follow-up questionnaire study. BMC Fam Pract. 2014;15(1):98. doi: 10.1186/1471-2296-15-98.
    1. Syrjä V, Parviainen L, Niemi A. Terveyskeskusten avosairaanhoidon järjestelyt 2019- Ulkoistukset, henkilöstö, työpanokset ja tehtäväsiirrot. Helsinki: Tutkimuksesta tiiviisti; 2019. p. 51.
    1. Siilinjärvi municipality. Population: Siilinjärvi; 2017. Available at: . Accessed 28 Oct 2018
    1. Tusa N, Kautiainen H, Elfving P, Sinikallio S, Mäntyselkä P. Relationship between patient activation measurement and self-rated health in patients with chronic diseases. BMC Fam Pract. 2020;21(1):225-y. doi: 10.1186/s12875-020-01301-y.
    1. Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33(5):328–336. doi: 10.3109/07853890109002086.
    1. Alanne S, Roine RP, Räsänen P, Vainiola T, Sintonen H. Estimating the minimum important change in the 15D scores. Qual Life Res. 2015;24(3):599–606. doi: 10.1007/s11136-014-0787-4.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–571. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Kasari D. Effect of exercise and fitness on serum lipids in college women University of Montana. 1976.
    1. Hicks VL, Stolarczyk LM, Heyward VH, Baumgartner RN. Validation of near-infrared interactance and skinfold methods for estimating body composition of American Indian women. Med Sci Sports Exerc. 2000;32(2):531–539. doi: 10.1097/00005768-200002000-00041.
    1. Jacob C. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Lawrence Erlbaum Associates; 1988.
    1. Hedges L, Ingram O. Statistical methods for meta-analysis. 1. London: Academic Press; 1985.
    1. Aro AK, Karjalainen M, Tiihonen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P. Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes. Prim Care Diabetes. 2017;11(6):577–582. doi: 10.1016/j.pcd.2017.07.001.
    1. Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: a systematic review and meta-analysis of observational studies. J Hypertens. 2011;29(2):179–188. doi: 10.1097/HJH.0b013e328340d76f.
    1. Korhonen PE, Kivelä SL, Kautiainen H, Järvenpää S, Kantola I. Health-related quality of life and awareness of hypertension. J Hypertens. 2011;29(11):2070–2074. doi: 10.1097/HJH.0b013e32834bbca7.
    1. Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;3:CD006560.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj