Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP) Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Community-Based Peer-Led Diabetes Self-management Cost analysis of a peer support programme for patients with type 2 diabetes: a secondary analysis of a controlled trial Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. A comparison of lay-taught and professional-taught arthritis self-management courses. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. Economic evaluation of arthritis self management in primary care Successes of a National Study of the Chronic Disease Self-Management Program: Meeting the Triple Aim of Health Care Reform Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement A randomized controlled study of the Arthritis Self-Management Programme in the UK. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country Outcomes of self-help education for patients with arthritis. The United Kingdom Expert Patients Programme: results and implications from a national evaluation. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial Re-thinking the relationship between long-term condition self-management education and the utilisation of health services. The relative effectiveness of self-management programs for type 2 diabetes. Challenges in Evaluating an Arthritis Self-management Program for People with Hip and Knee Osteoarthritis in Real-world Clinical Settings Internet-Based Chronic Disease Self-Management: A Randomized Trial A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Psychiatric Hospitalizations, Arrests, Emergency Room Visits, and Homelessness of Clients with Serious and Persistent Mental Illness: Findings from a Randomized Trial of Two ACT Programs vs. Usual Care The South Australia Health Chronic Disease Self-Management Internet Trial The expert patients programme online, a 1-year study of an Internet-based self-management programme for people with long-term conditions Self management of arthritis in primary care: randomised controlled trial Hispanic Chronic Disease Self-Management: A Randomized Community-Based Outcome Trial Is Individual Peer Support a Promising Intervention for Persons With Heart Failure? Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness. The Effects of a Collaborative Peer Advisor/Advanced Practice Nurse Intervention: Cardiac Rehabilitation Participation and Rehospitalization in Older Adults After a Cardiac Event The impact of a self-management group programme on health behaviour and healthcare utilization among congestive heart failure patients. Integrating behavioral healthcare for individuals with serious mental illness: A randomized controlled trial of a peer health navigator intervention Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes Community-based Spanish language arthritis education program: a randomized trial. Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease. Chronic disease self-management program for low back pain in the elderly. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: a survival analysis model. Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions
With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy OBJECTIVE To compare short-term and long-term effectiveness of the Arthritis Self-Help Course ( ASHC ) and the Chronic Disease Self-Management Program ( CDSMP ) for persons with arthritis concerning health care use , health-related quality of life , health behaviors , and arthritis self-efficacy . METHODS Forty-eight workshops were r and omized to the  ASHC ( n = 26 ) or CDSMP ( n = 22 ) . A total of 416 individuals , including 365 African Americans , participated . The mean age for each group was 64 years , mean years of education was 11.7 , mean number of chronic conditions was 4 , and 75 - 80 % of participants in each group were female . Multivariate statistical tests were used to assess effectiveness within and between programs for all workshop participants and African Americans . RESULTS At 4 months all ASHC participants including African Americans , had significant improvements ( P < or= 0.05 ) in self-efficacy , stretching and strengthening exercises , aerobic exercises , and general health . All CDSMP participants had statistically significant improvements in self-efficacy , disability , pain , and general health . African American CDSMP participants showed statistically significant improvements in general health . Trends toward improvement ( P = 0.051 - 0.100 ) were shown in 5 variables among African American CDSMP participants and in 4 variables among all CDSMP participants . Statistically significant differences between the 2 programs at 4 months were seen in pain and disability in both groups . The CDSMP produced stronger results . Significant results at 1 year within and between programs were minimal for both groups . CONCLUSION When population s with arthritis and multiple comorbid conditions are targeted , the CDSMP may be most cost effective Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation Background This study aim ed to explore if group-based peer support as an additional component to a disease management programme ( DMP ) in type 2 diabetes can reduce the number of prescribed drugs ; hospital admissions ; and length of hospital stay and therefore be a cost-effective model . Methods Controlled study based on a secondary data analysis of a cluster r and omized trial . Our study population was general practitioners and patients in the province of Salzburg . The 24-months intervention consisted of regular group meetings facilitated by trained peer supporters . The groups exercised together , discussed diabetes related topics , and received support by professionals . Data was anonymously collected on clusters through the statutory health insurance . Results Data were available of 118 ( 82.5%,17 clusters of the patients in the original r and omized trial ) participants in the intervention and 143 ( 77.3%,19 clusters ) in the control groups .  The length of hospital stay was shorter in the intervention groups compared with controls . The mean difference during the 24-month study period was -40.13 days ( 95 % CI - 78.54 to - 1.71 , P = 0.041 ) in favour of the intervention groups . No differences were seen in the number of prescribed drugs and hospital admission . Estimated yearly savings by reducing the length of hospital stay was € 1660.60 per patient . Conclusion A group-based peer support programme as an additional component of a DMP in type 2 diabetes is a promising approach to optimize diabetes care and to enhance lifestyle interventions in primary care . Peer support seems to reduce length of hospital stay and could therefore be a cost-effective model PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy . Limitations of most studies , however , include use of multiple outcome measures without pre design ated primary outcomes and lack of r and omized follow-up beyond 6 months . We conducted a 1-year r and omized controlled trial of Homing in on Health ( HIOH ) , a Chronic Disease Self-Management Program variant , addressing these limitations . METHODS We r and omized out patients ( N = 415 ) aged 40 years and older and who had 1 or more of 6 common chronic illnesses , plus functional impairment , to HIOH delivered in homes or by telephone for 6 weeks or to usual care . Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey‘s physical component ( PCS-36 ) and mental component ( MCS-36 ) summary scores . Secondary outcomes included the EuroQol EQ-5D and visual analog scale ( EQ VAS ) , hospitalizations , and health care expenditures . RESULTS Compared with usual care , HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks ( effect size = 0.27 ; 95 % CI , 0.10–0.43 ) and at 6 months ( 0.17 ; 95 % CI , 0.01–0.33 ) , but not at 1 year . In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome , the EQ VAS ( 1-year effect size = 0.40 ; CI , 0.14–0.66 ) . HIOH delivered by telephone had no significant effects on any outcomes . CONCLUSIONS Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies , in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization . These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program ( CDSMP ) . METHODS A r and omized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment ( waiting-list controls )  in five urban communities in Shanghai , China . Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately ; those in the control group received the same education and book six months later . FINDINGS In total , 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension , heart disease , chronic lung disease , arthritis , stroke , or diabetes who lived in communities were assigned r and omly to treatment ( n = 526 ) and control ( n = 428 ) groups . Overall , 430 ( 81.7 % ) and 349 ( 81.5 % ) patients in the treatment and control groups completed the six-month study . Patients who received treatment had significant improvements in weekly minutes of aerobic exercise , practice of cognitive symptom management , self-efficacy to manage own symptoms , and self-efficacy to manage own disease in general compared with controls . They also had significant improvements in eight indices of health status and , on average , fewer hospitalizations . CONCLUSION When implemented in Shanghai , the CDSMP was acceptable culturally to Chinese patients . The programme improved participants ' health behaviour , self-efficacy , and health status and reduced the number of hospitalizations six months after the course . The locally based delivery model was integrated into the routine of community government organizations and community health services . Chinese lay leaders taught the CDSMP courses as successfully as professionals Objective To assess the cost effectiveness of a self management programme plus education booklet for arthritis in primary care . Design Cost effectiveness and cost utility analysis from health and social care and societal perspectives alongside a r and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 or more with osteoarthritis of the hips or knees , or both , and pain or disability , or both . Interventions R and omisation to either six sessions of an arthritis self management programme plus an education booklet ( intervention group ) or the education booklet alone ( st and ard care control group ) . Main outcome measures Total health and social care costs and total societal costs at 12 months ; cost effectiveness ( incremental cost effectiveness ratios and cost effectiveness acceptability curves ) on basis of quality of life ( SF-36 , primary outcome measure ) , EuroQol visual analogue scale , and quality adjusted life years ( QALYs ) . Results At 12 months health and social care costs in the intervention group were £ 101 higher ( 95 % confidence interval £ 3 to £ 176 ) than those in the control group because the additional costs of the arthritis self management programme did not seem to be fully offset by savings elsewhere . There were no significant differences in societal costs ( which were up to 13 times the size of health and social care costs ) or any of the outcomes . From the health and social care perspective the intervention was dominated by the control on the basis of QALYs ( which were non-significantly lower in the intervention group ) and had incremental cost effectiveness ratios between £ 279 and £ 13 473 for the other outcomes . From the societal perspective the intervention seemed superior to the control owing to non-significantly lower costs and non-significantly better outcomes on all measures except QALYs . Probabilities of the arthritis self management programme ’s cost effectiveness ranged between 12 % and 97 % ( for thresholds ranging £ 0 to £ 1000 ) based on one point improvements in SF-36 outcomes , but the clinical significance of this is debatable . Probabilities of cost effectiveness on the basis of the visual analogue scale and QALYs were low . Conclusions Cost effectiveness of an arthritis self management programme is not suggested on the basis of current National Institute for Health and Clinical Excellence cost perspectives and QALY thresholds . The probability of cost effectiveness is greater when broader costs and other quality of life outcomes are considered . These results suggest that the cost effectiveness of the Department of Health ’s expert patients programme can not be assumed across all clinical conditions and that further rigorous evaluations for other conditions may be needed . Trial registration Current Controlled Trials IS RCT N79115352 Background : Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions .  Evidence -based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical , emotional , and social role management dem and s of chronic conditions . Objectives : To examine the effectiveness of the Chronic Disease Self-Management Program ( CDSMP ) among a national sample of participants organized around the Triple Aim goals of better health , better health care , and better value in terms of reduced health care utilization . Research Design : Utilizing data collected from small-group CDSMP workshops , baseline , 6-month , and 12-month assessment s were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects . Subjects : Data were analyzed from 1170 community-dwelling CDSMP participants . Measures : Triple Aim –related outcome measures : better health ( eg , self-reported health , pain , fatigue , depression ) , better health care ( eg , patient-physician communication , medication compliance , confidence completing medical forms ) , and better value [ eg , reductions in emergency room ( ER ) visits and hospitalizations in the past 6 mo ] . Results : Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up . The odds of ER visits significantly reduced from baseline to 12-month follow-up , whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up . Conclusions : This National Study of CDSMP ( National Study ) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Behavioral and health status outcomes of an unreinforced , self-help education program for arthritis patients taught by lay persons were examined in 2 ways : a 4-month r and omized experiment and a 20-month longitudinal study . At 4 months , experimental subjects significantly exceeded control subjects in knowledge , recommended behaviors , and in lessened pain . These changes remained significant at 20 months . The course was inexpensive and well-accepted by patients , physicians , and other health professionals The Expert Patients Programme ( EPP ) is a central element of chronic disease management policy in the United Kingdom . It aims to deliver self-care support by developing peoples ' self-care skills , confidence and motivation to take more effective control over their long-term conditions . A large , national r and omised controlled trial found that the EPP 's lay-led skills training was effective in improving self-efficacy and energy levels among patients with long-term conditions , and was likely to be cost-effective . Key questions remain as to whether existing outcome measures capture the core outcomes that are important to patients with long-term conditions . The development and evaluation of self-care support initiatives should take into account the extent to which self-care support initiatives can be integrated into peoples ' everyday lives , and the degree of fit with patients ' existing adaptations and strategies . Rather than being concentrated on a single course , central re sources for self-management support should be directed at a variety of systems and interventions that are able to meet the wide range of needs of patients with chronic conditions Objective : Supporting patients ’ self care could have a major effect on the management of long-term conditions , which has led to worldwide interest in effective self care interventions . In Engl and , self care support is being developed through the “ Expert Patients Programme ” , which provides lay-led generic courses to improve patients ’ self care skills . However , the clinical and cost effectiveness of such courses remains unclear . Methods : Two-arm pragmatic r and omised controlled trial design with waiting list control in community setting s in Engl and . 629 patients with a wide range of self-defined long-term conditions were studied . The lay-led self care support group involved 6-weekly sessions to teach self care skills . Primary outcomes were self-efficacy , reported energy and routine health services utilisation at 6 months . A cost-effectiveness analysis was also conducted . Results : Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up , but reported no statistically significant reductions in routine health services utilisation over the same time period . The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life , and a small reduction in costs . If a quality adjusted life year was valued at £ 20 000 ( $ 39 191 ; € 30 282 ) , there was a 70 % probability that the intervention was cost effective . Conclusions : Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions , and are likely to be cost effective over 6 months at conventional values of a decision-maker ’s willingness to pay . They may be a useful addition to current services in the management of long-term conditions Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved dem and management . However , the processes and imputed relationship between self-management education skills and health service contact are poorly understood . This paper reports on data from an embedded qualitative study which ran alongside a r and omised controlled trial in Engl and design ed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation . Drawing on concepts from the sociology of chronic illness , analyses suggest that the biographical and social context relevant to individuals ' experience of living with a long-term condition , history of health service utilisation , and relationships with health professionals are relevant to underst and ing the impact of self-management education and related policies aim ed at bringing about changes in service use . Our study suggests that future health policy assumptions about utilisation in the context of chronic disease management and self-care support polices may benefit by acknowledging the complex , context ual and recursive nature of health service utilisation operating in the life worlds of patients ' experience of living with a long-term condition OBJECTIVES The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs . METHODS The study used a 3-arm r and omized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program . In total , 405 persons completed baseline question naires and were r and omly allocated to a diabetes self-management program ( n=130 ) , to a general self-management program ( n=109 ) or to a control group ( n=122 ) . A 2-way factorial analyses of variance was employed as the primary statistical analysis . RESULTS The findings showed that the self-management programs had affected 5 of the 30 measures : fatigue , cognitive symptom management , self-efficacy with regard to the disease in general , communication with physician , and the score on the Diabetes Empowerment Scale . In addition , 3 variables-social role limitations , total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects . The second analysis found similar results , with 4 of the 5 measures remaining statistically significant : fatigue , cognitive symptom management , communication with physician and diabetes empowerment , with neither program being more effective than the other . CONCLUSIONS The major findings are that although both programs were effective in bringing about positive changes in the outcome measures , there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program . This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs Objective . To evaluate the influence of a 6-week Arthritis Self-Management Program ( ASMP ) on health-related quality of life ( HRQOL ) and self-management skills in clinical setting s. Methods . Individuals with hip or knee osteoarthritis referred to orthopedic surgeons or rheumatologists at 6 hospitals in Victoria , Australia , were recruited . In a r and omized controlled trial , participants received the Stanford ASMP and self-help book ( intervention ) or book only ( control ) . Assessment s included the Assessment of Quality of Life instrument ( AQoL ; range −0.04 to 1.00 ) and Health Education Impact Question naire ( heiQ ; range 1–6 ) at baseline and up to 12 months . The primary outcome was HRQOL at 12 months ( assessed using the AQoL ) . Results . Recruitment was concluded early due to persistent challenges including infrequent referrals and patient inability or disinterest in participating . Of 1125 individuals screened , only 120 were r and omized ( control , n = 62 ; intervention , n = 58 ) . Seven ASMP were conducted while 18 scheduled ASMP were cancelled . Forty-four of 58 intervention group participants received the intervention as allocated ( 76 % ) ; all control group participants were sent the book ( 100 % ) . Ninety-four participants ( 78 % ) completed 12-month assessment s ( control , 90 % ; intervention , 66 % ) . There was no difference in HRQOL at 12 months ( adjusted mean difference −0.02 , 95 % CI −0.09 to 0.05 ) . At 6 weeks , the intervention group reported higher heiQ skill and technique acquisition scores ( adjusted mean difference 0.29 , 95 % CI 0.04 to 0.55 ) ; however , this dissipated by 3 months . Conclusion . Significant challenges hampered this evaluation of the ASMP . The observed lack of enthusiasm from potential referrers and patients raises doubts about the practicality of this intervention in real-world setting s. ( ANZCTR Clinical Trials Registry no. ACTRN12606000174583 Background : The small-group Chronic Disease Self-Management Program ( CDSMP ) has proven effective in changing health-related behaviors and improving health statuses . An Internet-based CDSMP was developed to reach additional chronic-disease patients . Objectives : We sought to determine the efficacy of the Internet-based CDSMP . Design : We compared r and omized intervention participants with usual-care controls at 1 year . We compared intervention participants with the small-group CDSMP at 1 year . Subjects : Nine-hundred fifty-eight patients with chronic diseases ( heart , lung , or type 2 diabetes ) and Internet and e-mail access were r and omized to intervention ( 457 ) or usual care control ( 501 ) . Measures : Measures included 7 health status variables ( pain , shortness of breath , fatigue , illness intrusiveness , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 3 utilization variables ( physician visits , emergency room visits , and nights in hospital ) , and self-efficacy . Results : At 1 year , the intervention group had significant improvements in health statuses compared with usual care control patients . The intervention group had similar results to the small-group  CDSMP participants . Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year . Conclusions : The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program OBJECTIVE This study investigated the effectiveness of the Chronic Disease Self-management Program ( CDSMP ) when delivered to for people from Vietnamese , Chinese , Italian and Greek background s living in Victoria , Australia . METHOD The CDSMP was administered to 320 people with chronic illnesse(es ) in selected low income areas in the State of Victoria , Australia . At 6 months , they were compared with r and omised wait-list control subjects ( n=154 ) using analyses of covariance . RESULTS Participants in the intervention group had significantly better outcomes on energy , exercise , symptom management , self-efficacy , general health , pain , fatigue and health distress . There were no significant effects for health services utilisation . Interactions across language groups were observed with the Vietnamese and Chinese speaking participants gaining greater benefit . CONCLUSION Self-management programs can be successfully implemented with culturally and linguistically diverse population s in Australia . Further research is needed to evaluate long-term outcomes ; explore effects on service utilisation ; and to determine whether the benefits obtained from participating in a self-management program can be maintained . PRACTICE IMPLICATION S Self-management programs should be considered for people from culturally and linguistically diverse background s. Care also needs to be taken in design ing recruitment strategies to minimize withdrawal rates and to ensure harder to reach people are given encouragement to participate OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP Objective : This investigation examined several adverse outcomes in clients with serious mental illness in a r and omized trial of Assertive Community Treatment ( ACT ) versus usual care . Method : 163 subjects were r and omized to one of two ACT experimental conditions ( staffed by consumers or non-consumers ) or usual community care . Conditions were compared on psychiatric hospitalization , emergency room visit , arrest , and homelessness , within the two-year study period . Demographic , program , and client variables were examined for significant associations with outcomes . Results : Significant differences were found between ACT and usual care in time to first arrest , but not hospitalization , homelessness or ER visits . Shorter time to first hospitalization was associated with male gender , diagnoses other than schizophrenia , high psychiatric symptomatology and lower provider case load . ER visits were associated with increased client symptomatology . Shorter times to homelessness were predicted by poorer therapeutic alliance between case manager and clients . Shorter time to first arrest was predicted by client minority status and enrollment in usual care . Conclusions : The paucity of significant main effects may have been due to a prolonged “ start-up ” phase of the ACT programs , poor ACT implementation , restricted availability of psychiatric hospital beds , or changes in usual care services delivered over the study period Objectives . To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents . Method . Data were collected online at baseline , 6 months , and 12 months . The intervention was an asynchronous 6-week chronic disease self-management program offered online . The authors measured eight health status measures , seven behaviors , and four utilization measures ; self-efficacy ; and health care satisfaction . Results . Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data . One hundred forty-four completed 6 months and 194 completed 1 year . Significant improvements ( p < .05 ) were found at 6 months for four health status measures , six health behaviors , self-efficacy , and visits to emergency departments . At 12 months , five health status indicators , six health behaviors , self-efficacy , and visits to emergency departments remained significant . Satisfaction with health care trended toward significance . Discussion . The peer-led online program was both acceptable and useful for this population . It appeared to decrease symptoms , improve health behaviors , self-efficacy , and reduce health care utilization up to 1 year . This intervention also has large potential implication s for the use of a public health education model for reaching large numbers of people . It demonstrates that an Internet self-management program , which includes social media , can reach rural and underserved people as well as be effective and reduce health care costs . If this intervention can be brought to scale , it has the potential for improving the lives of large numbers of people with chronic illness . It represents a way the medical care and public health sectors can interact Objectives : Evaluate the effectiveness of an online self-management programme ( EPP Online ) for Engl and residents with long-term conditions . Methods : A prospect i ve longitudinal study . Data were collected online at baseline , 6 and 12 months . The intervention was an asynchronous 6-week chronic-disease self-management programme offered online . We measured seven health status measures ( health distress , self-rated health , illness intrusiveness , disability , fatigue , pain and shortness of breath ) , four behaviours ( aerobic exercise , stretching exercise , stress management and communications with physician ) , and five utilization measures ( GP visits , pharmacy visits , PT/OT visits , emergency visits and hospitalizations ) . We also measured self-efficacy and satisfaction with the health care system . Results : A total of 568 completed baseline data : 546 ( 81 % ) completed 6 months and 443 ( 78 % ) completed 1 year . Significant improvements ( p<0.01 ) were found at 6 months for all variables except self-rated health , disability , stretching , hospitalizations and nights in hospital . At 12 months only decrease in disability , nights in hospital and hospitalizations were not significant with reduction in visits to emergency departments being marginally significant ( p = 0.012 ) . Both self-efficacy and satisfaction with the health care system improved significantly . Discussion : The peer-led online programme conditions appears to decrease symptoms , improve health behaviours , self-efficacy and satisfaction with the health care system and reducing health care utilization up to 1 year Abstract Objective To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis . Design R and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 and over with osteoarthritis of hips or knees ( or both ) and pain or disability ( or both ) . Intervention Participants were r and omised to six sessions of self management of arthritis and an education booklet ( intervention group ) or the education booklet alone ( control group ) . Main outcome measures Primary outcome was quality of life , as assessed by the short form health survey ( SF-36 ) . Several other physical and psychosocial secondary outcomes were assessed . Data were collected at baseline , four months , and 12 months . Results Response rates were 80 % and 76 % at four and 12 months . The two groups showed significant differences at 12 months on the anxiety subscore of the hospital anxiety and depression scale ( mean difference −0.62 , 95 % confidence interval −1.08 to −0.16 ) , arthritis self efficacy scale for pain ( 0.98 , 0.07 to 1.89 ) , and self efficacy for other aspects of management ( 1.58 , 0.25 to 2.90 ) . Results were similar for intention to treat and per protocol analyses . No significant difference was seen in number of visits to the general practitioner at 12 months . Conclusions The self management of arthritis programme reduced anxiety and improved participants ' perceived self efficacy to manage symptoms , but it had no significant effect on pain , physical functioning , or contact with primary care . Trial registration Current Controlled Trials IS RCT N79115352 [ controlled-trials.com ] Background In light of health disparities and the growing prevalence of chronic disease , there is a need for community-based interventions that improve health behaviors and health status . These interventions should be based on existing theory . Objective This study aim ed to evaluate the health and utilization outcomes of a 6-week community-based program for Spanish speakers with heart disease , lung disease , or type 2 diabetes . Method The treatment participants in this study ( n = 327 ) took a 6-week peer-led program . At 4 months , they were compared with r and omized wait-list control subjects  ( n = 224 ) using analyses of covariance . The outcomes for all the treatment participants were assessed at 1 year , as compared with baseline scores ( n = 271 ) using t-tests . Results At 4 months , the participants , as compared with usual-care control subjects , demonstrated improved health status , health behavior , and self-efficacy , as well as fewer emergency room visits ( p < .05 ) . At 1 year , the improvements were maintained and remained significantly different from baseline condition . Conclusions This community-based program has the potential to improve the lives of Hispanics with chronic illness  while reducing emergency room use Peer support has been used effectively in a variety of patient population s , but its effectiveness in improving outcomes in persons with chronic heart failure has not been explored . We trained 9 persons with heart failure to mentor other heart failure patients  and tested the effectiveness of this approach in a r and omized controlled clinical trial . A low proportion ( 37 % ) of the eligible population of hospitalized patients agreed to participate . At the end of the 3-month trial , there was significantly higher heart failure self-care in the intervention group ( P < .05 ) . The only difference in social support was a significant decline in perceived support reciprocity in the intervention group ( F = 5.94 , P = .004 ) . No significant group differences in heart failure readmissions , length of stay , or cost were evident at 90-days , although the heart failure readmission rate was 96 % higher in the intervention group when compared to that in the control group . The reasons for low overall enrollment and high readmission rates in the intervention group require further study . Including additional self-care education by a professional , rather than leaving all the education to the mentor , could strengthen the peer support intervention trialed in this study . Small group meetings may be less intrusive and more desirable for this patient population OBJECTIVE Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions design ed to support illness self-management . This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness . METHODS A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were r and omly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care . Participants were evaluated on attitudinal , behavioral , and functional outcomes at baseline , at the end of the intervention , and at a two-month follow-up . RESULTS Living Well participants showed significant postintervention improvements across a range of attitudinal ( self-efficacy and patient activation ) , behavioral ( illness self-management techniques ) , and functional ( physical and emotional well-being and general health functioning ) outcomes . Although attenuation of effect was observed for most outcomes at two months postintervention , evidence was found of continued improvement in general self-management behaviors ( use of action planning , brainstorming , and problem-solving ) . Continued advantage was found for the Living Well group in other areas , such as health-related locus of control and reports of healthy eating and physical activity . Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care , although the between-group difference was not statistically significant . CONCLUSIONS Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being Background : After the cardiovascular events of myocardial infa rct ion ( MI ) and coronary artery bypass surgery ( CABS ) , unpartnered older adults are a vulnerable group that may benefit from interventions to improve health outcomes . The purpose of this analysis is to determine if a community-based collaborative peer advisor/advanced practice nurse intervention increased participation in cardiac rehabilitation programs and reduced hospital readmissions after MI and CABS and determine whether the type of cardiovascular event influenced rehospitalization . Subjects and Methods : This study was a r and omized clinical trial that enrolled 247 unpartnered older adults who were single , widowed , or divorced . Subjects were r and omized into 4 groups : st and ard of care group for MI and for CABS and st and ard of care plus the treatment groups for MI and for CABS , for 12 weeks after discharge . There were 163 women/84 men , with a mean age of 76.4 years , who were admitted for MI ( n = 93 ) or CABS ( n = 154 ) and who were enrolled from 5 academic medical centers . The treatment consisted of a community-based intervention of a home visit within 72 hours and telephone calls at 2 , 6 , and 10 weeks from an advanced practice nurse and 12 weekly telephone calls from a peer advisor .  Participation in a cardiac rehabilitation program and rehospitalizations were collected at 6 weeks and 3 , 6 , and 12 months by telephone interview . Results and Conclusions : There were significantly more participants in cardiac rehabilitation programs after 3 months in the treatment group , and this increase was seen up to 1 year after MI and CABS . There were no statistical differences , although there were fewer rehospitalizations between 3 and 6 months after MI and CABS in the treatment group compared with the st and ard of care group . Overall , the evidence from this study suggests that a community-based collaborative peer advisor/advanced practice nurse intervention can play a role in promoting active participation in cardiac rehabilitation programs and fewer rehospitalizations in unpartnered older adults after MI and CAGS AIMS The ' Chronic Disease Self-Management Programme ' ( CDSMP ) emphasizes patients ' responsibility for the day-to-day management of their condition(s ) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions . However , the effects of the CDSMP among congestive heart failure ( CHF ) patients are unknown . We therefore aim ed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF . METHODS AND RESULTS This r and omized , controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity . Control patients ( n = 131 ) received usual care , consisting of regular checkups at an outpatient clinic . Intervention group patients ( n = 186 ) received usual care and participated in a 6-week self-management group programme .  Favourable effects on walking for exercise and other physical activities such as aerobic , stretching , and strength exercises , sports , and gardening were reported in the intervention group immediately after completion of the programme . The effect of the programme on other physical activities extended to 6 months of follow-up . No favourable effects were found for the other outcomes . CONCLUSION The CDSMP significantly improved physical activity  among CHF patients for up to 6 months after the end of the programme ; however , it did not affect other health behaviour outcomes or healthcare utilization OBJECTIVE Individuals with serious mental illness also have high rates of comorbid physical health issues . To address those issues , this population needs interventions that improve self-management of health and healthcare . METHODS In order to improve the health and healthcare of individuals with serious mental illnesses , 151 consumers with serious mental illness were r and omized to receive either usual mental healthcare plus the Bridge intervention ( n=76 ) or usual mental healthcare while on a 6month waitlist ( n=75 ) . The waitlist group received the intervention after the waitlist period . RESULTS Change score comparisons ( difference of differences ) of the treatment vs the waitlist groups revealed that the treated group showed significantly greater improvement in access and use of primary care health services , higher quality of the consumer-physician relationship , decreased preference for emergency , urgent care , or avoiding health services and increased preference for primary care clinics , improved detection of chronic health conditions , reductions in pain , and increased confidence in consumer self-management of healthcare . CONCLUSIONS Peer providers using a manualized intervention can be an important part of the efforts to address the general medical care of individuals with serious mental illnesses Objectives .To assess the 1- and 2-year health status , health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program ( CDSMP ) . The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization . Design .Longitudinal design as follow-up to a r and omized trial . Setting .Community . Participants .Eight hundred thirty-one participants 40 years and older with heart disease , lung disease , stroke , or arthritis participated in the  CDSMP . At 1- and 2-year intervals respectively 82 % and 76 % of eligible participants completed data . Main Outcome Measures . Health status ( self-rated health , disability , social/role activities limitations , energy/fatigue , and health distress ) , health care utilization ( ER/outpatient visits , times hospitalized , and days in hospital ) , and perceived self-efficacy were measured . Main Results . Compared with baseline for each of the 2 years , ER/outpatient visits and health distress were reduced ( P < 0.05 ) . Self-efficacy improved ( P < 0.05 ) . The rate of increase is that which is expected in 1 year . There were no other significant changes . Conclusions .A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in population s with diverse chronic diseases OBJECTIVES To determine 4-month and 1-year health-related outcomes of a 6-week , lay-led , and community-based arthritis self-management program for Spanish-speaking participants and to determine the role of self-efficacy in predicting health status for this population . METHODS Three hundred and thirty one subjects were r and omized to the program or to a 4-month wait list control group . One hundred ninety eight subjects continued in a 1-year longitudinal study . Data were collected via mailed question naires with telephone follow up . RESULTS At 4 months , treatment subjects , compared with controls , demonstrated positive changes in exercise , disability , pain , and self-efficacy ( P < 0.05 ) . At 1 year , compared with baseline , treatment subjects demonstrated improvements in exercise , general health , disability , pain , self-efficacy , and depression ( P < 0.05 ) . Baseline and 4-month changes in self-efficacy predicted health status at 1 year . CONCLUSIONS Spanish-speaking participants of an arthritis self-management program demonstrate short- and long-term benefits ( improved health behaviors , health status , and self-efficacy ) BACKGROUND Reducing the impact of chronic disease in minority ethnic groups is an important public health challenge . Lay-led education may overcome cultural and language barriers that limit the effectiveness of professionally-led programmes . We report the first r and omised trial of a lay-led self-management programme - the Chronic Disease Self-Management Programme ( CDSMP ) ( Expert Patient Programme ) - in a south Asian group . AIM To determine the effectiveness of a culturally-adapted lay-led self-management programme for Bangladeshi adults with chronic disease . DESIGN OF STUDY R and omised controlled trial . SETTING Tower Hamlets , east London . METHOD We recruited Bangladeshi adults with diabetes , cardiovascular disease , respiratory disease or arthritis from general practice s and r and omised them to the CDSMP or waiting-list control .  Self-efficacy ( primary outcome ) , self-management behaviour , communication with clinician , depression scores , and healthcare use were assessed by blinded interviewer-administered question naires in Sylheti before r and omisation and 4 months later . RESULTS Of the 1363 people invited , 476 ( 34 % ) agreed to take part and 92 % ( 439/476 ) of participants were followed up . The programme improved self-efficacy ( difference : 0.67 , 95 % confidence interval [ CI ] = 0.08 to 1.25 ) and self-management behaviour ( 0.53 ; 95 % CI = 0.01 to 1.06 ) . In the 51 % ( 121/238 ) of intervention participants attending three or more of the 6-weekly education sessions the programme led to greater improvements in self-efficacy ( 1.47 ; 95 % CI = 0.50 to 1.82 ) and self-management behaviour ( 1.16 ; 95 % CI = 0.50 to 1.82 ) , and reduced HADS depression scores ( 0.64 ; 95 % CI = 0.07 to 1.22 ) . Communication and healthcare use were not significantly different between groups . The programme cost pound123 ( 181 ) per participant . CONCLUSION A culturally-adapted CDSMP improves self-efficacy and self-care behaviour in Bangladeshi patients with chronic disease . Effects on health status were marginal . Benefits were limited by moderate uptake and attendance OBJECTIVE To evaluate the effectiveness of Stanford 's Chronic Disease Self-Management Program ( CDSMP ) for chronic low back pain ( LBP ) in older Americans . DESIGN R and omized controlled trial . SETTING Community-based program offered at 12 locations . SUBJECTS Community-dwelling seniors ( n = 109 ) aged 60 and older with chronic LBP of mechanical origin . METHODS Patients were r and omly allocated to the CDSMP or to a 6-month , wait-list control group . The program included one 2.5-hour session per week for 6 weeks . Outcomes evaluated at 6 months included 100-point modified Von Korff pain and disability scales ; days with pain and disability ; SF-36 general health , energy-fatigue , and emotional well-being scales ; 2 scales from the Arthritis Self-Efficacy Scale , self-care attitudes/behaviors , and health services utilization . RESULTS For pain at 6 months , the primary outcome , the adjusted mean difference between the program and control , was -1.0 ( P = .835 ) . There was a sizable advantage for the program in disability averaged over the course of the entire 6-month study ( -9.2 , P = .027 ) , but not at the 6-month follow-up ( -5.8 , P = .278 ) . There was an interaction between intervention and baseline disability days favoring the program for higher baseline values ( P = .007 ) . The CDSMP affected emotional well-being ( 7.6 , P = .037 ) and energy-fatigue ( 5.1 , P = .274 ) . There were no differences for self-efficacy , pain days , and general health . CONCLUSION There was no advantage for the CDSMP over a wait-list control for improving pain , general health , self-efficacy , and self-care attitudes in older Americans with chronic LBP . A benefit was suggested for emotional well-being , fatigue , functional disability , and days with disability OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants OBJECTIVE This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs ( DSMP ) . We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization . METHODS Electronic medical records ( EMR ) were obtained for 376 adults enrolled in a r and omized controlled trial ( RCT ) of Type 2 diabetes ( T2DM ) self-management programs . All study participants had uncontrolled diabetes and were r and omized into either : personal digital assistant ( PDA ) , Chronic Disease Self-Management Program ( CDSMP ) , combined PDA and CDSMP ( COM ) , or usual care ( UC ) groups . Subjects were followed for a maximum of two years . Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization . RESULTS Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization ( Hazard ratio : 0.10 ; p=0.002 ) when compared to subjects in the control arm . Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm . CONCLUSION CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM . PRACTICE IMPLICATION S Reducing unnecessary healthcare utilization , particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs . The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients Objective : To assess the cost effectiveness of the Expert Patients Programme ( EPP ) intervention compared to a treatment as usual alternative . Design : Two-arm pragmatic r and omised controlled trial design with waiting list control . Setting : Community setting s in Engl and . Patients : Patients with a wide range of self-defined long-term conditions . Intervention : The EPP based on the US chronic disease self management program ( CDSMP ) , a lay-led self-care group involving six weekly sessions to teach self-care support skills . Main outcome measures : Costs estimated over a 6-month period from a societal perspective . Health outcomes estimated in terms of quality adjusted life years ( QALYs ) generated by patients ’ response to the EQ5D at baseline and 6-month follow-up . Results : The intervention group is associated with better patient outcomes , at slightly lower cost . Specifically , the intervention group has a 0.020 QALY gain compared with the control group , and a reduced cost of around £ 27 per patient . The intervention would therefore be considered dominant . While the QALYs gained are small in absolute terms , an additional 0.02 QALY is equivalent to an extra one week of perfect health per year . When the value of a QALY is £ 20 000 the EPP has a probability of 94 % of being cost effective . Indeed , for all plausible values of willingness-to-pay for a QALY the EPP group is more likely to be cost effective than the control group . Conclusions : The EPP intervention evaluated in this trial is very likely to provide a cost effective alternative to usual care in people with long-term conditions
Introduction : Chronically ill people are confronted with significant challenges when dealing with health care services .
Lay-led self-management programs aim to improve self-management skills and might enable patients to make appropriate decisions as to when to use health care services .
Contrary to the general attitude that self-management programs reduce health care utilisation , we suspect that better self-management skills lead to increased or possibly more appropriate health care utilisation .
Our review and meta- analysis sheds light on the relationship between lay-led self-management programs and health care utilisation .