The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial.
OBJECTIVE
Supporting patients' self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective self care interventions. In England, self care support is being developed through the "Expert Patients Programme", which provides lay-led generic courses to improve patients' self care skills. However, the clinical and cost effectiveness of such courses remains unclear.


METHODS
Two-arm pragmatic randomised controlled trial design with waiting list control in community settings in England. 629 patients with a wide range of self-defined long-term conditions were studied. The lay-led self care support group involved 6-weekly sessions to teach self care skills. Primary outcomes were self-efficacy, reported energy and routine health services utilisation at 6 months. A cost-effectiveness analysis was also conducted.


RESULTS
Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up, but reported no statistically significant reductions in routine health services utilisation over the same time period. The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life, and a small reduction in costs. If a quality adjusted life year was valued at 20,000 pounds (39,191 dollars; 30,282 Euro), there was a 70% probability that the intervention was cost effective.


CONCLUSIONS
Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions, and are likely to be cost effective over 6 months at conventional values of a decision-maker's willingness to pay. They may be a useful addition to current services in the management of long-term conditions.
Kennedy
Anne
A
National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Manchester M13 9PL, UK. anne.p.kennedy@manchester.ac.uk
Reeves
David
D
Bower
Peter
P
Lee
Victoria
V
Middleton
Elizabeth
E
Richardson
Gerry
G
Gardner
Caroline
C
Gately
Claire
C
Rogers
Anne
A
D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000191:economics; D020377:Self Efficacy; D012657:Self-Help Groups / Q000191:economics / Q000458:organization & administration*