Community Health Care Services Research Articles

‘I'll be in a safe place’: a qualitative study of the decisions taken by people with advanced cancer to seek emergency department care

ObjectiveTo explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process.DesignCross-sectional qualitative study incorporating...

Mobility impairment, social engagement, and life satisfaction among the older population in China: a structural equation modeling analysis.

Revealing the relationship between mobility impairment and life satisfaction can help to propose effective interventions to secure mobility and life satisfaction. However, the relationship remains unclear and lacks quantitative evidence in China. This study therefore assesses the association of mobility impairment, social engagement, and life satisfaction among the older population in China. Based on the sample of China Health and Retirement Longitudinal Survey database in 2013, a structural equation modeling is established. The sample size is 4245 with 55.9% with mobility impairment. The model shows that the length of suffering from disability is significantly related to mobility impairment (β=0.058, p<0.001). Mobility impairment is inversely related to social engagement (β=-0.300, p<0.001) and life satisfaction (β=-0.311, p<0.001). Social engagement is positively related to life satisfaction (β=0.211, p<0.001). Moreover, the relationships have some differences for the seniors with different sociodemographic characteristics and living in different residential areas. As seniors get older, they tend to have more severe mobility impairment and participate less in social activities. Those with higher mobility impairment are more likely to report lower life satisfaction partly because they usually participate less in social activities. Different strategies are suggested to be adopted to improve the life satisfaction of the older population from the aspects of promoting mobility and social engagement, including improving the design of transport facilitates, providing assistive facilities for the seniors with severe mobility impairment, promoting the accessibility of community leisure and healthcare services, and constructing more community senior activity centers.

Rural Veterans’ Utilization of Non‒Veterans Administration Community Health Care Services

Rural veterans are obtaining non‒Veterans Administration health care at an increasing rate, but information on what community services are accessed is lacking. A secondary analysis of surveys obtained from 6 previous studies conducted in acute care areas was scrutinized for military history and utilization patterns. Depending on age, multiple health care agencies were used. Acute care was relied upon frequently, most often due to pain. The Veterans Administration was infrequently visited. Clinician electronic documentation of military history, inquiry into use of other health care services, and involvement in research to monitor outcomes are suggested to facilitate identification of health needs specific to this population.

Balancing the use of language to enable care: a qualitative study of oral and written language used in assessments and allocations of community healthcare services for persons with dementia.

BackgroundAlthough a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals.Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers’ justifications for their choice of words.MethodsA qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions.ResultsThe purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma.ConclusionsDespite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1659-0) contains supplementary material, which is available to authorized users.

Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study.

BackgroundPeople struggling with chronic pain may benefit from different types of non-pharmacological interventions such as self-management courses. Self-management courses aim to increase participants’ skills and knowledge in managing chronic conditions. Community health-care services in Norway have increasingly established Healthy Life Centres (HLCs) to offer easily accessible interventions to people in need of support to better handle a life with chronic illness. The aim of this trial is to investigate the expectations, effect and experience of an easily accessible, group-based self-management course delivered at a HLC for people with chronic pain.Methods/DesignThis is an open pragmatic two-armed randomised controlled trial with an embedded qualitative study. The intervention is a self-management course comprising education, discussions, exchange of experiences between the participants, and physical movement exercises. The control group is offered a drop-in outdoor physical activity. The intervention period is 6 weeks. The primary outcome is patient activation measured by the patient activation measure (PAM). The secondary outcomes include measures of self-efficacy, pain and quality of life. Data will be collected at baseline, and after 3, 6 and 12 months. Using a mixed linear model, the number needed in each arm to achieve a power of 80 % becomes 55. To allow for dropout, the aim is to include 120 participants. Analysis will be done using mixed linear models. In the embedded qualitative study, we will perform semi-structured face-to-face interviews with a sample from both trial arms before randomisation and after 3 and 12 months. The topics elaborated will be motivation for participation and experiences with the activity related to possible changes in managing and coping with chronic pain.DiscussionThere is need for more knowledge on interventions delivering self-care support in an easily accessible way that aim to reach those in need of this kind of health service. This trial will produce important knowledge on the effect and the experiences of participants in such an easily accessible self-management course delivered in Norwegian public primary care.Trial registrationClinicalTrials.gov: NCT02531282. Registered on 21 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1462-6) contains supplementary material, which is available to authorized users.

Healthcare students as innovative partners in the development of future healthcare services: An action research approach

BackgroundHealth care systems in Norway and the western world have experienced extensive changes due to patients living longer with complex conditions that require coordinated care. A Norwegian healthcare reform has led to significant restructuring in service delivery as a devolution of services to municipalities. Action Research DesignPartners from three rural healthcare services, students from four professional programmes, and one lecturer from each of the professional programmes used a collaborative approach to obtain new knowledge through interprofessional practice. Using an action research design, the research group facilitated democratic processes through dialogues with healthcare services and students. The design is visualised as a cyclical process in which each cycle contributes to improvements, innovations, and increased understanding. A total of 32 students and 3 supervisors were interviewed before and after the clinical practice experiences. Fieldwork was conducted during three clinical periods. FindingsInterprofessional student groups formed small healthcare teams and assessed patients with chronic and long-term conditions. Students prepared and negotiated patient follow-up. The teams' responsibilities led to reflective practices that enhanced their professional knowledge. The teams achieved a new understanding of patient situations, which influenced “second opinions” for patients with complex conditions and led to innovative practices. The change in perception of patient needs led to a changed professional approach. The students' perceptions changed as they learned from and about each other and in collaboration with the health service; this led to more coordinated care of patients with complex conditions. Interprofessional learning in community settings provided a platform to improve both healthcare education and rural healthcare services. ConclusionThis research contributes to knowledge of how students' placement in interprofessional teams can enhance students learning from, with and about each other. The student teams promoted new ways of approaching and delivering complex patient treatment and care in community healthcare service. Collaborative partnerships in interprofessional learning have potential in the wider international arena as a means for practice improvement.

Healthcare Managers’ Perceptions of Patient Perpetrated Aggression and Prevention Strategies: A Cross Sectional Survey

Patient or client aggression towards staff is a risk in healthcare. Healthcare takes place in a variety of settings, including hospitals, community, and Aged Care facilities. A minimal amount is known regarding the existence of safety and training measures available throughout the broad range of hospital and community healthcare services. A web-based survey of the type and frequency of violence experienced by healthcare staff was sent to unit managers working in mental health and older peoples’ services of District Health Boards, Non-Governmental Organisations, and Aged Care facilities across New Zealand. One hundred and forty-one managers responded to the survey with a response rate of 79.21%. Managers reported high rates of verbal aggression and assaults against staff within their services. A total of 60% of respondents stated that an increase in assaults against staff was due to an increase in violent events and 43.1% related this to increased staff awareness and reporting of violent events to management. Communication skills and de-escalation training were provided across approximately 95% of organisations. The availability of safety measures including panic buttons, personal alarms, use of security personnel, and police assistance were more widely available and accessible within hospital settings and the community sector was found to mostly rely on police for assistance when violence occurs. The perception of violence is high in healthcare. Prevention and management training is provided in public hospital and aged care setting but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence based aggression prevention programmes.

Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland.

To conduct an economic evaluation of intensive management by Indigenous health workers (IHWs) of Indigenous adults with poorly controlled type 2 diabetes in rural and remote north Queensland. Cost-consequence analysis alongside a cluster randomised controlled trial of an intervention delivered between 1 March 2012 and 5 September 2013. Twelve primary health care services in rural and remote north Queensland communities with predominantly Indigenous populations. Indigenous adults with poorly controlled type 2 diabetes (HbA1c ≥ 69 mmol/mol) and at least one comorbidity (87 people in six IHW-supported communities (IHW-S); 106 in six usual care (UC) communities). Per person cost of the intervention; differential changes in mean HbA1c levels, percentage with extremely poor HbA1c level control, quality of life, disease progression, and number of hospitalisations. The mean cost of the 18-month intervention trial was $10 060 per person ($6706 per year). The intervention was associated with a non-significantly greater reduction in mean HbA1c levels in the IHW-S group (-10.1 mmol/mol v -5.4 mmol/mol in the UC group; P = 0.17), a significant reduction in the proportion with extremely poor diabetes control (HbA1c ≥ 102 mmol/mol; P = 0.002), and a sub-significant differential reduction in hospitalisation rates for type 2 diabetes as primary diagnosis (-0.09 admissions/person/year; P = 0.06), with a net reduction in mean annual hospital costs of $646/person (P = 0.07). Quality of life utility scores declined in both groups (between-group difference, P = 0.62). Rates of disease progression were high in both groups (between-group difference, P = 0.73). Relative to the high cost of the intervention, the IHW-S model as implemented is probably a poor investment. Incremental cost-effectiveness might be improved by a higher caseload per IHW, a longer evaluation time frame, and improved service integration. Further approaches to improving chronic disease outcomes in this very unwell population need to be explored, including holistic approaches that address the complex psychosocial, pathophysiological and environmental problems of highly disadvantaged populations. ANZCTR12610000812099.

Caring through discipline? Analyzing house rules in community mental health services in Norway

In Scandinavian countries, public housing and recreation programs for people suffering from mental health or substance abuse problems emphasize normalization of life and participation in a normal social life. The theoretical approach taken by community health care services has been de-institutionalization. To study if and how this movement from patient to fully participating citizen was reflected in these new institutions, written house rules in sheltered housing and day centers for adults were collected and analyzed by content analysis. The findings show that the formal language represents the voice of professionals, while the content pertained to regulation of the service user’s daily life. House rules mostly mediate an image of the service user as a person in need of being controlled, and the ideological practices of hospital-managed care seem to be maintained.

Effect of modular-based community learning about diabetes mellitus among undergraduate students

Background: Community learning with the help of academic module is an active learning experience for medical students to learn by observation, develop communication skill, participatory action research, and confidence building. Objective: To enhance knowledge of diabetes mellitus (DM) among medical students by involving them in community-based teaching. Materials and Methods: After ethical permissions, both the faculties prepared a module on DM, which was self explanatory and informative for students for teaching and for community people for learning. Students gave knowledge on risk factors, clinical features, diagnosis, and lifestyle modification for diabetes management to community people with the help of academic module on DM. Visits were supervised by faculty, paramedical staff and social workers with the help of checklists and video recordings. Pre- and posttests were conducted for students on the topic DM. Feedback from students, faculty, and community people about need for modular community learning was studied. Results: A total of 80 students participated in this study. A significant rise of 59.0% in mean average score of students, from baseline (pretest 5.46 vs posttest 8.68) was observed. Checklist and video analysis revealed an improvement in subject knowledge, logical reasoning, communication skills, and problem solving skills of students. Analysis of feedback from students revealed an attitudinal change, feeling confident of community practice. Faculty felt an improvement in communication skills of students and faculty showed an interest in research projects at community organizations. Community people were benefited by students’ engagement in knowledge sharing and providing health needs. Conclusion: Modular community learning program for medical undergraduates has the potential to enhance students’ academic learning in community health environment and strengthen self-confidence and communication skills. It may bring about better community health-care services.

Accountable Care Organisations fund the gap—how to get community paramedic programmes paid

Community care paramedic services In the United States (US) are seeking solutions in the wake of the Affordable Care Act. Health care is moving into a new era: it is transitioning away from a fee for service model to a model based on continued improved patient outcomes. This shift to focused patient-centered care is nothing new to paramedics. They sit in the community waiting to respond at a moment's notice to provide life-saving and life-sustaining care from the time they are dispatched, to the time they arrive at the emergency room. With the implementation of community care paramedic programmes they have the opportunity to expand upon simply providing transport services. Now the opportunity exists to not just sit and wait for the emergency but to be part of keeping patients from getting sicker and helping to manage them before they call 911. Finding a way to fund community paramedic programmes that provide these much needed healthcare services is where the current healthcare reform will provide solutions. Filling the gaps between integrated community health care services is viable through existing Accountable Care Organisations that are supported legislatively and can fiscally help these programmes succeed in this new era of health care.

African Americans and Clinical Research: Evidence Concerning Barriers and Facilitators to Participation and Recruitment Recommendations.

The goal of the study was to examine barriers and facilitators to clinical research participation among African Americans, as well as recommendations for overcoming these. Eight focus groups were conducted consisting of 64 individuals. These focus groups targeted 2 groups of individuals: (a) community members, including both individuals involved in research and individuals not involved in research, and (b) community leaders, including clergy, community health care providers and service providers who may influence decisions to participate in research. Among participants in both groups, the most common barriers to participation included fear and mistrust of research due to multiple factors, such as a lack of information about research and prevailing knowledge of historical occurrences. Facilitators to research participation included intrinsic factors, such as a desire to help others, and extrinsic factors, such as familiarity with the research recruiter. The focus groups also directly engaged participants in discussions of strategies that might improve recruitment, such as the importance of providing personal stories that enable community members to understand the potential benefits of research. Findings from these focus groups address the mandate from funding agencies that emphasize the importance of including racially diverse populations in clinical research studies, and offer potential solutions for increasing the recruitment and retention of minority participants.

Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

Preserving the Social Contract of Health Care--A Call to Action.

The authors reflect on bias and substandard medical services in health care services for many minority communities and the need to recognize and mediate biases that are undermining relations between medical personnel and minority patients. They comment on community service for medical students and mention it is rarely a formal part of residency tor medical school training. They comment on implicit bias and the impact of bias within patient care, and the need to connect with communities.

Abstract A12: Developing an intervention to promote colorectal cancer control among multiethnic minorities

Abstract Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Screening for colorectal cancer has been shown to be effective in reducing incidence and mortality from the disease. Yet, Behavior Risk Factor Surveillance System data has shown that minority populations (African American, Hispanic, and Asian/Pacific Islander) are less likely to report being up to date with colorectal cancer (CRC) screening and having a colonoscopy within 10 years (60.0, 46.0, and 49.9%), when compared to whites (62.5%). Many barriers (lack of transportation, lack of access, fear, fatalism, low levels of health literacy, and lower levels of English proficiency) to CRC screening among minorities have been reported. However, studies have also demonstrated navigators, which include lay persons and health professional from the community to be effective at increasing screening among minority populations. Purpose: To increase capacity for navigators to promote colorectal cancer prevention and control in their community and/or health care setting. Methods: Twenty-two multiethnic navigators from partnering organizations that provide healthcare services for African American, Asian, and Latino communities were invited to participate in the “A Walk through the Cure” intervention. Participants were led on a walking tour of colorectal cancer care related centers, including Colorectal Health Center, Colorectal Surgery, Oncology Clinic and Infusion Center, Oncology Radiation Center and Cancer Resource Center at the University of Chicago Medicine. Each stop of the tour was staffed by a faculty member. A mini lecture was given by the faculty at each stop and participants were encouraged to ask questions. The tour lasted about two hours. Quantitative and qualitative data were collected through a survey with open-ended questions. Findings: All participants demonstrated an increase in colorectal cancer control related knowledge, by comparing a pre and post self-assessment. Additionally, the navigators reported that their increased knowledge and familiarity with the CRC screening and treatment process facilitated increased levels of confidence to encourage patients or community members to screen for CRC. “I have accurate statistics related to CRC and the importance of screening, which helps me encourage patients or people in my community to do screening without any fear.” Conclusion: This data indicates the importance of innovative strategies to facilitate increased capacity among navigators to promote colorectal cancer prevention and control in minority communities. Citation Format: Lisa Hinton, Helen Lam, Karen Kim. Developing an intervention to promote colorectal cancer control among multiethnic minorities. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A12.

Overcoming barriers to health-care access: A qualitative study among African migrants in Guangzhou, China

ABSTRACTGuangzhou is China's third most populous city, and the region's burgeoning manufacturing economy has attracted many young African businessmen and entrepreneurs to the city. The aims of this study were to examine strategies that African migrants in Guangzhou have adopted in response to health-care barriers, and explore their perceptions of how to address their needs. Twenty-five semi-structured interviews and two focus groups were conducted among African migrants residing in Guangzhou, China. Facing multiple barriers to care, African migrants have adopted a number of suboptimal and unsustainable approaches to access health care. These included: using their Chinese friends or partners as interpreters, self-medicating, using personal connections to medical doctors, and travelling to home countries or countries that offer English-speaking doctors for health care. Health-care providers and health organisations in Guangzhou have not yet acquired sufficient cultural competence to address the needs of African migrants residing in the city. Introducing linguistically and culturally competent health-care services in communities concentrated with African migrants may better serve the population. With the growing international migration to China, it is essential to develop sustainable approaches to improving health-care access for international migrants, particularly those who are marginalised.

“Bringing the future to life: Maureen’s postcard to Beryl”=North Wales Regional Single Point of Access Programme

Purpose The purpose of this paper is to reflect on the journey so far for the North Wales Regional Single Point of Access (SPOA) through the lens of programme manager with views from the programme team. SPOA is the integration of access points to community health and social care services with strengthened links to the third sector, one SPOA in each of six local authorities in the Betsi Cadwallader University Health Board footprint. Design/methodology/approach Kotter’s 8 step theory of change model (1996) supplemented by the organisational, cultural and professional and contextual factors from research that impact on integrated working between health and social care (Cameron et al., 2012); the focus is programme level. Findings Kotter’s 8 step model is a useful tool for reflection on the factors identified in research that promote and hinder integrated working. Key messages and innovative ideas of interest for practitioners embarking on a similar “Quest”, including: “keep using your ‘levers for change’”, “Adopt and Adapt”, “right people in the right place”, “it’s ok to tweak your vision, ‘Make it mean something to everyone’, ‘accept and Adapt’, ‘Don’t sweat what you can’t affect’, ‘Find your allies – it’s better together’, ‘Celebrate ‘small wins’’, ‘The people’s voice drives change’ and ‘a sense of humour brings you through’”. Research limitations/implications This is a personal reflection from the North Wales Regional SPOA Programme. Originality/value It makes use of collaborative work focused on delivering a SPOA, helping others to learn from the struggle.

Factors associated with aggressive end of life cancer care.

BackgroundMany patients with cancer experience aggressive care towards the end of life (EOL) despite evidence of an association with poor outcomes such as prolonged pain and overall dissatisfaction with care.PurposeTo investigate socio-demographic, clinical and community health care service factors associated with aggressive EOL cancer care.MethodsAn analysis of pooled data from two mortality follow-back surveys was performed. Aggressive EOL care was defined as greater than or equal to one of the following indicators occurring during the last 3 months of life: greater than or equal to two emergency department visits, ≥30 days in hospital and death in hospital.ResultsOf the 681 included patients, 50.1 % were men and mean age at death was 75 years. The majority of patients (59.3 %, 95 % confidence interval (CI) 55.6–63.0 %) experienced at least one indicator of aggressive EOL care: 29.7 % experienced greater than or equal to two ED visits, 17.1 % spent ≥30 days in hospital and 37.9 % died in hospital. Patients with prostate or haematological cancer were more likely to experience aggressive EOL care (adjusted odds ratio (AOR) 4.36, 95 % CI 1.39–13.70, and 4.16, 95 % CI 1.38–12.47, respectively, reference group lung cancer). Patients who received greater than five general practitioner (GP) home visits (AOR 0.37, 95 % CI 0.17–0.82, reference group no GP visits) or had contact with district nursing (AOR 0.48, 95 % CI 0.28–0.83, reference group no contact) or contact with community palliative care services (AOR 0.27, 95 % CI 0.15–0.49, reference group no contact) were less likely to experience aggressive EOL care. No association was found between aggressive EOL care and patients’ age, gender, marital, financial or health status.ConclusionsCommunity health care services, in particular contact with community palliative care, are associated with a significant reduction in the odds of cancer patients receiving aggressive EOL care. Expansion of such services may help address the current capacity crises faced by many acute health care systems.

The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages

Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services

ObjectivesTo evaluate the Flinders Program in improving self-management in common chronic conditions. To examine properties of the Partners in Health scale (PIH). MethodsParticipants were randomized to usual care or Flinders Program plus usual care. Self-management competency, quality of life, and other outcomes were measured at baseline, 6 months, and 12 months. ResultsOf 231 participants, 172 provided data at 6 months and 61 at 12 months. At 6 months, intention-to-treat outcomes favoured the intervention group for SF-12 physical health (p=0.043). Other pre-determined outcomes did not show significance. At 6 months intervention participants’ problem severity scores reduced (p<0.001) and goal achievement scores increased (p<0.001). Only 55% of the intervention group received a Flinders Program, compromising study power. The PIH was associated with other measures at baseline and for change over time. ConclusionIn a pragmatic community trial, the Flinders Program improved quality of life at 6 months. Incomplete in-practice intervention delivery limited trial power. Studies are now needed on improving delivery. The PIH has potential as a generic risk screening tool and predictive measure of change in self-management and chronic condition outcomes over time. Practice implicationsBetter implementation including service integration is required for improved chronic disease management.