title: Effectiveness of personalised support for self-management in primary care: a cluster randomised controlled trial.
abstract: BACKGROUND
  Self-management support is an important component of the clinical management of many chronic conditions. The validated Self-Management Screening questionnaire (SeMaS) assesses individual characteristics that influence a patient's ability to self-manage.
  
  
  OBJECTIVE
  To assess the effect of providing personalised self-management support in clinical practice on patients' activation and health-related behaviours.
  
  
  METHODS
  A cluster randomised controlled trial was conducted in 15 primary care group practices in the south of the Netherlands.
  
  
  METHODS
  After attending a dedicated self-management support training session, practice nurses in the intervention arm discussed the results of SeMaS with the patient at baseline, and tailored the self-management support. Participants completed a 13-item Patient Activation Measure (PAM-13) and validated lifestyle questionnaires at baseline and after 6 months. Data, including individual care plans, referrals to self-management interventions, self-monitoring, and healthcare use, were extracted from patients' medical records. Multilevel multiple regression was used to assess the effect on outcomes.
  
  
  RESULTS
  The PAM-13 score did not differ significantly between the control (n = 348) and intervention (n = 296) arms at 6 months. In the intervention arm, 29.4% of the patients performed self-monitoring, versus 15.2% in the control arm (effect size r = 0.9, P = 0.01). In the per protocol analysis (control n = 348; intervention n = 136), the effect of the intervention was significant on the number of individual care plans (effect size r = 1.3, P = 0.04) and on self-monitoring (effect size r = 1.0, P = 0.01).
  
  
  CONCLUSIONS
  This study showed that discussing SeMaS and offering tailored support did not affect patient activation or lifestyle, but did stimulate patients to self-monitor and use individual care plans.
authors.affiliation: Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Eikelenboom
authors.affiliation: Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.affiliation: Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Jacobs
authors.affiliation: Psychologist (Doen en blijven doen), Eindhoven, the Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Verhulst
authors.affiliation: Researcher Philips Research, Eindhoven, the Netherlands.
authors.forename: Joyca
authors.initials: J
authors.lastname: Lacroix
authors.affiliation: Researcher Philips Research, Eindhoven, the Netherlands.
authors.forename: Aart
authors.initials: A
authors.lastname: van Halteren
authors.affiliation: De Ondernemende Huisarts Care Group, Eindhoven, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Klomp
authors.affiliation: De Ondernemende Huisarts Care Group, Eindhoven, the Netherlands.
authors.forename: Ivo
authors.initials: I
authors.lastname: Smeele
authors.affiliation: Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D057285:Precision Medicine; D011320:Primary Health Care / Q000379:methods*; D040242:Risk Reduction Behavior; D012648:Self Care; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: chronic disease; personalised medicine; primary care; self-care; self-management