title: Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial.
abstract: BACKGROUND
  Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.
  
  
  RESULTS
  In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.
  
  
  CONCLUSIONS
  An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN45433299.
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Blickem
authors.affiliation: NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gaffney
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gardner
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Praksha
authors.initials: P
authors.lastname: Jariwala
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Shoba
authors.initials: S
authors.lastname: Dawson
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Rahena
authors.initials: R
authors.lastname: Mossabir
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Brooks
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, United Kingdom.
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, United Kingdom.
authors.forename: Eldon
authors.initials: E
authors.lastname: Spackman
authors.affiliation: NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: Primary Care & Health Services, University of Keele, Staffordshire, United Kingdom.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012944:Social Support; D011795:Surveys and Questionnaires; D013689:Telephone