title: A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services.
abstract: OBJECTIVE
  To evaluate the Flinders Program in improving self-management in common chronic conditions. To examine properties of the Partners in Health scale (PIH).
  
  
  METHODS
  Participants were randomized to usual care or Flinders Program plus usual care. Self-management competency, quality of life, and other outcomes were measured at baseline, 6 months, and 12 months.
  
  
  RESULTS
  Of 231 participants, 172 provided data at 6 months and 61 at 12 months. At 6 months, intention-to-treat outcomes favoured the intervention group for SF-12 physical health (p=0.043). Other pre-determined outcomes did not show significance. At 6 months intervention participants' problem severity scores reduced (p<0.001) and goal achievement scores increased (p<0.001). Only 55% of the intervention group received a Flinders Program, compromising study power. The PIH was associated with other measures at baseline and for change over time.
  
  
  CONCLUSIONS
  In a pragmatic community trial, the Flinders Program improved quality of life at 6 months. Incomplete in-practice intervention delivery limited trial power. Studies are now needed on improving delivery. The PIH has potential as a generic risk screening tool and predictive measure of change in self-management and chronic condition outcomes over time.
  
  
  CONCLUSIONS
  Better implementation including service integration is required for improved chronic disease management.
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia. Electronic address: malcolm.battersby@flinders.edu.au.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battersby
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Harris
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Flinders Southern Adelaide Clinical School AU, General Practice, Flinders University, Adelaide, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Reed
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Woodman
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003153:Community Health Services; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012648:Self Care; D013997:Time Factors
keywords: Chronic disease management; Pragmatic randomized trial; Primary care; Self-management support