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Person-Centred Care Can Help Patients to Become More Effective Consumers in the Use of Health Information than Regular Care – an RCT in Patients with Arthritis Undergoing Biological Therapy
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. FoU Spenshult, Halmstad, Sweden.ORCID iD: 0000-0002-4341-660X
FoU Spenshult, Halmstad, Sweden; Lund University, Lund, Sweden & The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID iD: 0000-0002-6294-538X
Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. FoU Spenshult, Halmstad, Sweden & Lund University, Lund, Sweden.ORCID iD: 0000-0002-8081-579X
2015 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 67, no Suppl. S10, 1495Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background/Purpose:

Person-centred care (PCC) is a holistic approach with respectful and individualized care allowing negotiation of care where persons with health problems are empowered to be involved in health decisions. Patients’ illness narratives constitute a starting point for building a collaboration with health care professionals and to empower them to play an active role in their health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers. The aim was to study the impact on effective consumers’ skills over 6 and 12 months as measured by the Effective Consumer Scale (EC17) in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) based on regular care.

Methods:

A 12 month RCT in 107 patients with chronic inflammatory arthritis1. Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was randomized to either at an NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT, including five subscales; 1. Use of health information, 2. Clarifying personal priorities, 3. Communicating with others, 4. Negotiating roles and 5. Deciding and taking action. EC17 total score ranges from 0-100, worse to best. Differences between and within NLC and RLC were analyzed with Friedmans’ test or Mann Whitney U-test.

Results:

After 12 months 97 patients completed the RCT (NLC n=47, RLC n=50), mean (SD) age 55.4 (12.7) years, disease duration 16.7 (11.5) years, DAS28 2.1 (0.7), HAQ 0.54 (0.38), global health 20.4 (17.1), pain 21.1 (18.0) and 56% were women. There were no statistically significant differences within or between the two intervention groups at baseline nor in EC17 total score mean (SD) at baseline (NLC 83.5 (9.4) vs. RLC 83.2 (10.8), 6 months (NLC 85.4 (10.4) vs. RLC 82.9 (10.9) and 12 months (NLC 85.3 (11.1) vs. RLC 82.3 (10.9)). However, in NLC there was a statistically significant improvement in EC17 subscale “1. Use of health information” at both 6 and 12 months (p=0.041 and p=0.004 respectively).

Conclusion:

Replacing just one of three visits over 12 months to an NLC based on PCC instead of an RLC based on regular care resulted in more effective consumers concerning the use of health information. Larger studies over longer time frames focusing on PCC are needed to better understand its full impact on effective consumer skills measured by EC17.

References:

1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70:164-75.

Place, publisher, year, edition, pages
Hoboken, NJ: John Wiley & Sons, 2015. Vol. 67, no Suppl. S10, 1495
Keyword [en]
arthritis management, nursing roles and patient-reported outcome measures, RCT
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-29847DOI: 10.1002/art.39448ISI: 000370860202756OAI: oai:DiVA.org:hh-29847DiVA: diva2:875168
Conference
2015 ACR/ARHP Annual Meeting, San Francisco, CA, USA, November 6-11, 2015
Available from: 2015-11-30 Created: 2015-11-30 Last updated: 2016-11-28Bibliographically approved

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