Stewart W Mercer1, Bridie Fitzpatrick2, Lesley Grant2, Nai Rui Chng3, Alex McConnachie4, Andisheh Bakhshi4, Greg James-Rae4, Catherine A O'Donnell2, Sally Wyke3. 1. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom Stewart.Mercer@ed.ac.uk. 2. Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom. 3. College of Social Sciences, University of Glasgow, Glasgow, United Kingdom. 4. Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Abstract
PURPOSE: To assess the effect of a primary care-based community-links practitioner (CLP) intervention on patients' quality of life and well-being. METHODS: Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. PRIMARY OUTCOME: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). SECONDARY OUTCOMES: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked. RESULTS: Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources. CONCLUSIONS: We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.
RCT Entities:
PURPOSE: To assess the effect of a primary care-based community-links practitioner (CLP) intervention on patients' quality of life and well-being. METHODS: Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. PRIMARY OUTCOME: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). SECONDARY OUTCOMES: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked. RESULTS: Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources. CONCLUSIONS: We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.
Authors: Karen Barnett; Stewart W Mercer; Michael Norbury; Graham Watt; Sally Wyke; Bruce Guthrie Journal: Lancet Date: 2012-05-10 Impact factor: 79.321
Authors: F D Richard Hobbs; Clare Bankhead; Toqir Mukhtar; Sarah Stevens; Rafael Perera-Salazar; Tim Holt; Chris Salisbury Journal: Lancet Date: 2016-04-05 Impact factor: 79.321
Authors: Søren T Skou; Frances S Mair; Martin Fortin; Bruce Guthrie; Bruno P Nunes; J Jaime Miranda; Cynthia M Boyd; Sanghamitra Pati; Sally Mtenga; Susan M Smith Journal: Nat Rev Dis Primers Date: 2022-07-14 Impact factor: 65.038
Authors: Bridget Kiely; Barbara Clyne; Fiona Boland; Patrick O'Donnell; Deirdre Connolly; Eamon O'Shea; Susan M Smith Journal: BMJ Open Date: 2021-02-01 Impact factor: 2.692
Authors: Bridget Kiely; Deirdre Connolly; Barbara Clyne; Fiona Boland; Patrick O'Donnell; Eamon O Shea; Susan M Smith Journal: J Multimorb Comorb Date: 2021-05-20