Abstract
BackgroundLimited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results.MethodsSecondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions.ResultsParticipants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16–3.55), Emotional well-being (1.97; 1.05–3.68), Self-monitoring and insight (2.35; 1.02–5.40), Constructive attitudes and approaches (2.91; 1.45–5.84), Skill and technique acquisition (1.96; 1.13–3.39), and Health services navigation (2.52; 1.21–5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight.ConclusionsThe intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results.Trial registrationClinicalTrials.gov Identifier: NCT01319656
Highlights
Limited studies exist on successful interventions for patients with multimorbidity
[10] The positive effect of self-management support is known for single chronic diseases, [11] but little is known about the impact of such programs among patients with multimorbidity
It has been reported that multimorbidity occurs 10–15 years earlier in more socioeconomically deprived areas and is more prevalent in patients with lower socioeconomic status. [3, 13] Given the need to account for the heterogeneity of multimorbidity; the authors of the above-mentioned review suggested that interventions could have differential effects depending on the socioeconomic status of participants
Summary
Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results. [3, 4] despite its high prevalence and its important burden on patients’ health, there is limited evidence supporting care strategies for patients with multimorbidity. [10] The positive effect of self-management support is known for single chronic diseases, [11] but little is known about the impact of such programs among patients with multimorbidity. A systematic review of interventions in primary care and the community for the management of patients with multimorbidity suggested that interventions addressing risk factors or functional difficulties seemed more effective, but consideration of the impact of the socioeconomic factor was minimal [12].
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