title: Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial.
abstract: OBJECTIVE
  To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care.
  
  
  METHODS
  Pragmatic, two arm, cluster randomised controlled trial.
  
  
  METHODS
  General practices, serving a population in northwest England with high levels of deprivation.
  
  
  METHODS
  5599 patients with a diagnosis of diabetes (n=2546), chronic obstructive pulmonary disease (n=1634), and irritable bowel syndrome (n=1419) from 43 practices (19 intervention and 22 control practices).
  
  
  METHODS
  Practice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were employed by the health management organisation.
  
  
  METHODS
  Primary outcomes were shared decision making, self efficacy, and generic health related quality of life measured at 12 months. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity, and enablement.
  
  
  RESULTS
  We randomised 44 practices and recruited 5599 patients, representing 43% of the eligible population on the practice lists. 4533 patients (81.0%) completed the six month follow-up and 4076 (72.8%) the 12 month follow-up. No statistically significant differences were found between patients attending trained practices and those attending control practices on any of the primary or secondary outcomes. All effect size estimates were well below the prespecified threshold of clinically important difference.
  
  
  CONCLUSIONS
  An intervention to enhance self management support in routine primary care did not add noticeable value to existing care for long term conditions. The active components required for effective self management support need to be better understood, both within primary care and in patients' everyday lives.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN90940049.
authors.affiliation: Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK. a.kennedy@soton.ac.uk
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.forename: Robert
authors.initials: R
authors.lastname: Bowen
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.forename: Martin
authors.initials: M
authors.lastname: Eden
authors.forename: Catherine
authors.initials: C
authors.lastname: Fullwood
authors.forename: Hannah
authors.initials: H
authors.lastname: Gaffney
authors.forename: Caroline
authors.initials: C
authors.lastname: Gardner
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
authors.forename: Rebecca
authors.initials: R
authors.lastname: Morris
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
authors.forename: Angela
authors.initials: A
authors.lastname: Swallow
authors.forename: David
authors.initials: D
authors.lastname: Thompson
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003657:Decision Making; D019468:Disease Management; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D006113:United Kingdom