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Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial
To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chro...
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| Published in: | Annals of family medicine 2021-03, Vol.19 (2), p.126-134 |
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| Main Authors: | , , , , , , , , , , , , , |
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| container_end_page | 134 |
| container_issue | 2 |
| container_start_page | 126 |
| container_title | Annals of family medicine |
| container_volume | 19 |
| creator | Fortin, Martin Stewart, Moira Ngangue, Patrice Almirall, José Bélanger, Mathieu Brown, Judith Belle Couture, Martine Gallagher, Frances Katz, Alan Loignon, Christine Ryan, Bridget L Sampalli, Tara Wong, Sabrina T Zwarenstein, Merrick |
| description | To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices.
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 Questionnaire); and self-efficacy.
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.
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;
= .006, and physical activity with OR 3.43;
= .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.
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 combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention. |
| doi_str_mv | 10.1370/afm.2650 |
| format | article |
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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 Questionnaire); and self-efficacy.
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.
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;
= .006, and physical activity with OR 3.43;
= .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.
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 combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.2650</identifier><identifier>PMID: 33685874</identifier><language>eng</language><publisher>United States: Annals of Family Medicine</publisher><subject>Care and treatment ; Comorbidity ; Health care teams ; Management ; Methods ; Original Research ; Primary health care</subject><ispartof>Annals of family medicine, 2021-03, Vol.19 (2), p.126-134</ispartof><rights>2021 Annals of Family Medicine, Inc.</rights><rights>COPYRIGHT 2021 Annals of Family Medicine</rights><rights>2021 Annals of Family Medicine, Inc. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-158b2d177fdee51169070c5f4af4697bd5462a0942be216a60ed30cb072bf16b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939717/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939717/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,733,786,790,891,27957,27958,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33685874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fortin, Martin</creatorcontrib><creatorcontrib>Stewart, Moira</creatorcontrib><creatorcontrib>Ngangue, Patrice</creatorcontrib><creatorcontrib>Almirall, José</creatorcontrib><creatorcontrib>Bélanger, Mathieu</creatorcontrib><creatorcontrib>Brown, Judith Belle</creatorcontrib><creatorcontrib>Couture, Martine</creatorcontrib><creatorcontrib>Gallagher, Frances</creatorcontrib><creatorcontrib>Katz, Alan</creatorcontrib><creatorcontrib>Loignon, Christine</creatorcontrib><creatorcontrib>Ryan, Bridget L</creatorcontrib><creatorcontrib>Sampalli, Tara</creatorcontrib><creatorcontrib>Wong, Sabrina T</creatorcontrib><creatorcontrib>Zwarenstein, Merrick</creatorcontrib><title>Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices.
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 Questionnaire); and self-efficacy.
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.
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;
= .006, and physical activity with OR 3.43;
= .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.
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 combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.</description><subject>Care and treatment</subject><subject>Comorbidity</subject><subject>Health care teams</subject><subject>Management</subject><subject>Methods</subject><subject>Original Research</subject><subject>Primary health care</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNptkl9rFDEUxQdRbK2Cn0ACgvRl1iTz3wdhGaoWuli0fQ6Z5GY2kkm2SUas-OHN2nXpwhJILsnvnnAPJ8teE7wgRYPfczUtaF3hJ9kpqcoyJw1pnu5r3J1kL0L4gTEltKDPs5OiqNuqbcrT7M93wY22I7rdoGseNdiY92kDDxJdbk-pg9CbxHB_j3ruASnn0Wo2UU_OD1rqeP8BLdG15-OUFARa6V8g8xXEtZMBfeNWukn_Tnq9s9E7Y1J54zU3L7NnipsAr3bnWXb76eKm_5Jfff182S-vclHhNuakagcqSdMoCVARUne4waJSJVdl3TWDrMqactyVdABKal5jkAUWA27ooEg9FGfZxwfdzTxMIEWaz3PDNl5PaSjmuGaHL1av2eh-sqYrumRlEjjfCXh3N0OIbEqugDHcgpsDo2WXyKKgbULfPqAjN8C0VS4pii3OlnVVdSXp_lH5EWoEC-l7Z0HpdH3AL47waUmYtDja8O5Rwxq4ievgzBy1s-EQ3I0mvAvBg9rbQjDbhoulcLFtuBL65rGNe_B_moq__CPKFA</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Fortin, Martin</creator><creator>Stewart, Moira</creator><creator>Ngangue, Patrice</creator><creator>Almirall, José</creator><creator>Bélanger, Mathieu</creator><creator>Brown, Judith Belle</creator><creator>Couture, Martine</creator><creator>Gallagher, Frances</creator><creator>Katz, Alan</creator><creator>Loignon, Christine</creator><creator>Ryan, Bridget L</creator><creator>Sampalli, Tara</creator><creator>Wong, Sabrina T</creator><creator>Zwarenstein, Merrick</creator><general>Annals of Family Medicine</general><general>American Academy of Family Physicians</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210301</creationdate><title>Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial</title><author>Fortin, Martin ; Stewart, Moira ; Ngangue, Patrice ; Almirall, José ; Bélanger, Mathieu ; Brown, Judith Belle ; Couture, Martine ; Gallagher, Frances ; Katz, Alan ; Loignon, Christine ; Ryan, Bridget L ; Sampalli, Tara ; Wong, Sabrina T ; Zwarenstein, Merrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-158b2d177fdee51169070c5f4af4697bd5462a0942be216a60ed30cb072bf16b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Care and treatment</topic><topic>Comorbidity</topic><topic>Health care teams</topic><topic>Management</topic><topic>Methods</topic><topic>Original Research</topic><topic>Primary health care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fortin, Martin</creatorcontrib><creatorcontrib>Stewart, Moira</creatorcontrib><creatorcontrib>Ngangue, Patrice</creatorcontrib><creatorcontrib>Almirall, José</creatorcontrib><creatorcontrib>Bélanger, Mathieu</creatorcontrib><creatorcontrib>Brown, Judith Belle</creatorcontrib><creatorcontrib>Couture, Martine</creatorcontrib><creatorcontrib>Gallagher, Frances</creatorcontrib><creatorcontrib>Katz, Alan</creatorcontrib><creatorcontrib>Loignon, Christine</creatorcontrib><creatorcontrib>Ryan, Bridget L</creatorcontrib><creatorcontrib>Sampalli, Tara</creatorcontrib><creatorcontrib>Wong, Sabrina T</creatorcontrib><creatorcontrib>Zwarenstein, Merrick</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fortin, Martin</au><au>Stewart, Moira</au><au>Ngangue, Patrice</au><au>Almirall, José</au><au>Bélanger, Mathieu</au><au>Brown, Judith Belle</au><au>Couture, Martine</au><au>Gallagher, Frances</au><au>Katz, Alan</au><au>Loignon, Christine</au><au>Ryan, Bridget L</au><au>Sampalli, Tara</au><au>Wong, Sabrina T</au><au>Zwarenstein, Merrick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>19</volume><issue>2</issue><spage>126</spage><epage>134</epage><pages>126-134</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-4</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-News-2</notes><notes>content type line 23</notes><notes>ObjectType-Article-3</notes><abstract>To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices.
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 Questionnaire); and self-efficacy.
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.
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;
= .006, and physical activity with OR 3.43;
= .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.
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 combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.</abstract><cop>United States</cop><pub>Annals of Family Medicine</pub><pmid>33685874</pmid><doi>10.1370/afm.2650</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| subjects | Care and treatment Comorbidity Health care teams Management Methods Original Research Primary health care |
| title | Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial |
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