Family Medicine Publications

Title

Scaling up patient-centered interdisciplinary care for multimorbidity: A pragmatic mixed-methods randomized controlled trial

Document Type

Article

Publication Date

1-1-2021

Journal

Annals of Family Medicine

Volume

19

Issue

2

First Page

126

Last Page

134

URL with Digital Object Identifier

10.1370/afm.2650

Abstract

PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifac-eted intervention based on a change in care delivery for patients with multimor-bidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Ques-tionnaire); and self-efficacy. Secondary outcomes: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The com-bination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.

Notes

Copyright © 2021 Annals of Family Medicine, Inc.

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