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Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial

  • Julie Richardson (a1), Lori Letts (a1), David Chan (a2), Paul Stratford (a1), Carri Hand (a1), David Price (a2), Linda Hilts (a2), Liliana Coman (a1), Mary Edwards (a1), Sue Baptiste (a1) and Mary Law (a1)...
Abstract
Aim

The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention.

Background

More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management.

Methods

A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme.

Findings

Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days (F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of $65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.

Copyright
Corresponding author
Correspondence to: Dr Julie Richardson, Associate Professor, School of Rehabilitation Science, McMaster University, IAHS 403, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada. Email: jrichard@mcmaster.ca
References
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Allore, H.G., Tinneti, M., Gill, T.M.Peduzzi, P.N. 2005: Experimental designs for multicomponent interventions among persons with multifactorial geriatric syndromes. Clinical Trials 2, 1321.
Anderson, R.Wagner, E. 2003: Chronic illness management: what is the role of primary care? Annals Internal Medicine 138, 256261.
Barr, V., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D.Salivaras, S. 2003: The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model. Hospital Quarterly 7, 7382.
Beck, A., Scott, J., Williams, P., Robertson, B., Jackson, D., Gade, G.Cowan, P. 1997: A randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic. Journal of the American Geriatrics Society 45, 543549.
Boult, C., Boult, L., Morishita, L., Dowd, B., Kane, R.Urdangarin, C. 2001: A randomized clinical trial of outpatient geriatric evaluation and management. Journal of the American Geriatrics Society 49, 351359.
Boult, L., Boult, C., Pirie, P.Pacala, J.T. 1994: Test-retest reliability of a questionnaire that identifies elders at risk for hospital admission. Journal of the American Geriatrics Society 42, 707711.
Brazier, J., Harper, R., Jones, N., O’Cathain, A., Thomas, K., Usherwood, T.Westlake, L. 1992: Validation of the SF-36 health survey questionnaire: a new outcome measure for primary care. British Medical Journal 305, 160164.
Burns, R., Nichols, L., Martindale-Adams, J.Graney, M. 2000: Interdisciplinary geriatric primary care evaluation and management: two year outcomes. Journal of the American Geriatrics Society 48, 813.
Butland, R.J., Pang, C., Gross, E., Woodcock, A.A.Geddes, D.M. 1982: Two-, six-, and twelve-minute walk test in respiratory disease. British Medical Journal 284, 16071608.
Coleman, E., Grothaus, L., Sandhu, N.Wagner, E. 1999: Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. Journal American Geriatrics Society 47, 118.
Coleman, E., Wagner, E., Grothaus, L., Hecht, J., Savarino, J.Buchner, D. 1998: Predicting hospitalization and functional decline in older health plan enrollees: are administrative data as accurate as self-report? Journal of the American Geriatrics Society 46, 419425.
Craig, P., Dieppe, P., MacIntyre, S., Michie, S., Nazareth, I.Pettigrew, M. 2008: Developing and evaluating complex interventions: the new Medical Research Council Guidance. British Medical Journal 337, 979983.
Dubois, N. 2003: An overview of chronic disease prevention. Ontario health promotion E-Mail bulletin no. 312.1.
Franks, P., Nutting, P.Clancy, C. 1993: Health care reform, primary care, and the need for research. Journal of the American Medical Association 270, 14491453.
Grumbach, K.Bodenheimer, T. 2002: A primary care home for Americans: putting the house in order. Journal of the American Medical Association 288, 889893.
Guralnik, J., Simonsick, E., Ferrucci, L., Berkman, L., Blazer, G.Wallace, P. 1994: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journals of Gerontology 2, M85M94.
Haley, S., Jette, A., Coster, W., Kooyoomijian, J.T., Levenson, S.Ashba, J. 2002: Late life function and disability instrument. II development and evaluation of the function component. Journal of Gerontology A Biological Science 57A, M209M216.
Hall, J., Milburn, M.A.Epstein, A.M. 1993: A causal model of health status and satisfaction with medical care. Medical Care 31, 8494.
Hayward, R., Bernard, A., Freeman, H.Corey, C. 1991: Regular source of ambulatory care and access to health services. American Journal Public Health 81, 434438.
Health Canada. 2001: About primary care. Ottawa: Health Canada. Retrieved 14 May 2009 from http://www.hc-sc.gc.ca/hcs-sss/prim/about-apropos-eng.php
Hemingway, H., Stafford, M., Stanfield, S., Shipley, M.Marmot, M. 1997: Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. British Medical Journal 315, 12731279.
Hopman, W., Berger, C., Joseph, L., Towheed, T., VandenKerhof, E., Anastassiades, T., Adachi, J.D., Ioannidis, G., Brown, J.P., Hanley, D.A.Papadimitropoulos, E.A., CaMos Research Group. 2006: The natural progression of health-related quality of life: results of a five-year prospective study of SF-36 scores in a normative population. Quality of Life Research 15, 527536.
Hopman, W., Towheed, T., Anastassiades, T., Tenenhouse, A., Poliquin, S., Berger, C., Joseph, L., Brown, J.P., Murray, T.M., Adachi, J.D., Hanley, D.A.Papadimitropoulos, E.A., CaMos Research Group. 2000: Canadian normative data for the SF-36 health survey. Canadian multicentre osteoporosis study research group. Canadian Medical Association Journal 163, 265271.
Hurley, R., Freund, D.Taylor, D. 1989: Emergency room use and primary care case management: evidence from four medicaid demonstration programs. American Journal Public Health 79, 843846.
Jette, A.M., Haley, S.M., Coster, W.J., Kooyoomijian, J.T., Levenson, S.Ashba, J. 2002: Late life function and disability instrument I. Development and evaluation of the disability component. Journal of Gerontology A: Biological Science 57A, M209M216.
Keith, R.A. 1998: Patient satisfaction and rehabilitation services. Archives Physical Medicine and Rehabilitation 79, 11221128.
Landon, B.E., LeRoi, S., Hicks, M.D., O’Malley, J., Lieu, T., Keegan, T., McNeil, B.J.Guadagnoli, E. 2007: Improving the management of chronic disease at community health centres. New England Journal of Medicine 356, 921934.
Leveille, S., Wagner, E., Davis, C., Grouthaus, L., Wallace, J., LoGerfo, M.Kent, D. 1998: Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. Journal of the American Geriatrics Society 46, 11911198.
Lorig, K., Stewart, A., Ritter, P. et al. 1996: Outcome measures for health education and other health care interventions. Thousand Oaks, CA: Sage Publications.
Mackenzie, L., Byles, J.Higginbotham, N. 2000: Designing the home falls and accidents screening tool (HOME FAST): selecting the item. British Journal of Occupational Therapy 63, 260269.
Mackenzie, L., Byles, J.Higginbotham, N. 2002a: Professional perceptions about home safety: cross-national validation of the Home Falls and Accidents Screening Tool (HOME FAST). Journal of Allied Health 31, 2228.
Mackenzie, L., Byles, J.Higginbotham, N. 2002b: Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) for identifying older people at increased risk of falls. Disability and Rehabilitation 24, 266274.
Marriot, J.Mable, A.L. 2000: Health policy and communications branch. Ottawa: Health Canada, 1117.
Marshall, M.Hays, R. 1994: The patient satisfaction questionnaire short-form (PSQ-18). Santa Monica: Rand Corporation.
Moore, G.Showstack, J. 2003: Primary care medicine in crisis: toward reconstruction and renewal. Annals of Internal Medicine 138, 244247.
Morishita, L., Boult, C., Boult, L., Smith, S.Pacala, J. 1998: Satisfaction with outpatient geriatric evaluation and management. The Gerontologist 38, 303308.
Pacala, J., Boult, C.Boult, L. 1995: Predictive validity of a questionnaire that identifies older persons at risk for hospital admission. Journal of the American Geriatrics Society 43, 374377.
Pincus, T. 2002: Limitations of randomized clinical trials in chronic diseases: explanations and recommendations. Advances 18, 1421.
Post, M., Festen, H., van de Port, I.G.Visser-Meily, J.M. 2007: Reproducibility of the caregiver strain index and the caregiver reaction assessment in partners of stroke patients living in the Dutch community. Clinical Rehabililtation 21, 10501055.
Rantanen, T., Volpato, S., Ferrucci, L., Heikkinen, E., Fried, L.Gurlanik, J. 2003: Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. Journal of the American Geriatrics Society 51, 636641.
Reuben, D., Frank, J., Hirsch, S., McGuigan, K.Maly, R. 1999: A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. Journal of the American Geriatrics Society 47, 269276.
Richardson, J., Letts, L., Chan, D., Baptiste, S., Edwards, M., Coman, L., Price, D., Hilts, L., Stratford, P.Law, M. 2006: Multidisciplinary approach to primary care not “two-tiered”. Ontario Medical Review July/August, 910.
Robinson, B. 1983: Validation of a caregiver strain index. Journal of Gerontology 38, 344348.
Schraeder, C., Shelton, P.Sager, M. 2001: The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adult. Journal of Gerontology: Medical Sciences 56A, M106M112.
Scott, J.C., Conner, D.A., Venohr, I., Gade, G., Mackenzie, M., Kramer, A.M., Bryant, L.Beck, A. 2004: Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinics. Journal of the American Geriatrics Society 52, 14631470.
Tinnetti, M.Fried, T. 2004: The end of the disease era. The American Journal of Medicine 116, 179185.
Tinnetti, M., Bogardus, S.T.Agostini, J.V. 2004: Potential pitfalls of disease-specific guidelines for patients with multiple conditions. New England Journal of Medicine 348, 15561564.
Wagner, E.H. 1998: Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice 1, 24.
Wagner, E.H., Glascow, R.E., Davis, C., Bonomi, A.E., Provost, L., McCulloch, D., Carver, P.Sixta, C. 2001: Quality improvement in chronic illness care: a collaborative approach. 27, 6380.
Wagner, E.H., Austin, B.T.Von Korff, M. 1996: Organizing care for patients with chronic illness. The Milbank Quarterly 74, 511544.
Way, D., Jones, L., Baskerville, B.Busing, N. 2001: Primary health care services provided by nurse practitioners and family physicians in shared practice. Cananian Medical Association Journal 165, 12101214.
Weinberger, M., Oddone, E.Henderson, W. 1996: Does increased access to primary care reduce hospital readmission? New England Journal of Medicine 334, 14411447.
Wilson, A., Oldenberg, B.F.Lopez, A.D. 2003: Targeted approaches for reducing inequities in chronic disease. Medical Journal of Australia 179, 222223.
World Health Organization. 2007: Facts related to chronic diseases and the WHO global strategy on diet, physical activity and health. Geneva, Switzerland. Retrieved 5 August 2009 from http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/index.html.
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
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