A5054371848- Chronic Disease Management Strategies
- Primary Care and Health Outcomes
- Diabetes Management and Education
- Health Systems, Economic Evaluations, Quality of Life
- Sleep and Wakefulness Research
- Health Policy Implementation Science
- Sleep and related disorders
- Grief, Bereavement, and Mental Health
- Interprofessional Education and Collaboration
- Research in Social Sciences
- Mental Health and Patient Involvement
- Patient-Provider Communication in Healthcare
- Trauma and Emergency Care Studies
- Dialysis and Renal Disease Management
- Child Abuse and Trauma
- Blood Pressure and Hypertension Studies
- Community Development and Social Impact
- Patient Satisfaction in Healthcare
- Sleep and Work-Related Fatigue
- Legal Issues in South Africa
- Economic and Environmental Valuation
- Social Policy and Reform Studies
- Community Health and Development
- Family Caregiving in Mental Illness
- Family and Patient Care in Intensive Care Units
University of Manchester
2007-2023
Manchester Academic Health Science Centre
2012-2023
University of Oxford
2023
National Institute for Health Research
2013-2019
Manchester University
2012
National Computing Centre (United Kingdom)
2007-2010
University of York
2008
The Centre for Health (New Zealand)
2008
Providence Sacred Heart Medical Center
2006
Sacred Heart Medical Center
2006
<b>Objective:</b> Supporting patients’ self care could have a major effect on the management of long-term conditions, which has led to worldwide interest in effective interventions. In England, support is being developed through “Expert Patients Programme”, provides lay-led generic courses improve skills. However, clinical and cost effectiveness such remains unclear. <b>Methods:</b> Two-arm pragmatic randomised controlled trial design with waiting list control community settings England. 629...
The management of people with multiple chronic conditions challenges health-care systems designed around single conditions. There is international consensus that care for multimorbidity should be patient-centred, focus on quality life, and promote self-management towards agreed goals. However, there little evidence about the effectiveness this approach. Our hypothesis was so-called 3D approach (based dimensions health, depression, drugs) patients would improve their health-related which...
<b>Objective</b> To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care. <b>Design</b> Pragmatic, two arm, cluster randomised controlled trial. <b>Setting</b> General practices, serving a population northwest England high levels deprivation. <b>Participants</b> 5599 diagnosis diabetes (n=2546), obstructive pulmonary disease (n=1634), and irritable bowel syndrome (n=1419) from 43 practices (19 22 control...
Insomnia is prevalent and distressing but access to the first-line treatment, cognitive behavioural therapy (CBT), extremely limited. We aimed assess clinical cost-effectiveness of sleep restriction therapy, a key component CBT, which has potential be widely implemented.We did pragmatic, superiority, open-label, randomised controlled trial versus hygiene. Adults with insomnia disorder were recruited from 35 general practices across England randomly assigned (1:1) using web-based...
The Expert Patients Programme (EPP) is a central element of chronic disease management policy in the United Kingdom. It aims to deliver self-care support by developing peoples' skills, confidence and motivation take more effective control over their long-term conditions. A large, national randomised controlled trial found that EPP's lay-led skills training was improving self-efficacy energy levels among patients with conditions, likely be cost-effective. Key questions remain as whether...
Implementation of long-term condition management interventions rests on the notion whole systems re-design, where incorporating wider elements health care are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus particular or outcomes a sub-system. A randomised controlled trial SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary showed no effect patient-level outcomes. This...
An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. evidence based training package using a whole systems approach implemented as part randomised controlled trial was delivered to general practice staff. The found no effect intervention on patient outcomes. This paper explores why failed become normal practice. We focussed tools which capture two key aspects – education (guidebooks patients) forming collaborative...
Participation in health care is an important element of self-management chronic illness, and policy emphasises patient’s choice. Evidence suggests that this may be inequitable inadequate, since active participation strongly associated with socio-demographic variables. This qualitative study explores the perceptions people differing socio-economic status themes related to literacy relationship health-care professionals. Patients perceive different ways, their prior expectations a...
Background Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed presence other co-morbidities. This trial aimed determine effectiveness an intervention provide information and telephone-guided access versus usual for patients with stage 3 CKD. Methods Findings In pragmatic, two-arm,...
To assess the cost effectiveness of Expert Patients Programme (EPP) intervention compared to a treatment as usual alternative.Two-arm pragmatic randomised controlled trial design with waiting list control.Community settings in England.Patients wide range self-defined long-term conditions.The EPP based on US chronic disease self management program (CDSMP), lay-led self-care group involving six weekly sessions teach support skills.Costs estimated over 6-month period from societal perspective....
Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce impact these on life and burden care utilisation. There is significant interest potential for self-management support improve utilisation patient populations, but little consensus concerning optimal model that would best provide such support. We describe implementation evaluation through an evidence-based 'whole systems' involving support, training primary teams,...
In England, the Expert Patients Programme, a lay-led chronic disease self-management course, was developed to improve self-care support and skills. The course is designed for anyone with self-defined long-term condition, attracts heterogeneous group of patients. A randomised controlled trial has demonstrated effectiveness in improving subjective health. However, it not known whether particular patient characteristics predict impact course.
The WISE (Whole System Informing Self-management Engagement) approach encompasses creating, finding, and implementing appropriate self-care support for people with long-term conditions. A training package primary care to introduce the was developed underwent formative evaluation. This entailed exploring acceptability of its effectiveness in changing communication within consultations. study aimed refine patient, practitioner, patient level components translate principles into an operational...
Background. Shared decision making (SDM) and patient self-management support are key components of US UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial implementing training in primary care physicians one region. This article describes preintervention levels patient-reported explores how this varies with practice characteristics. Methods. We analyzed baseline data from a cluster randomized...
Improving the quality of care for people with vascular disease is a key priority. Chronic kidney (CKD) has recently been included as target condition general practices to add registers chronic conditions part Quality and Outcome Framework. This paper outlines implementation evaluation self-management intervention involving an information guidebook, tailored access local resources telephone support stage 3 disease. The study involves multi-site, longitudinal patient-level randomized...
Background People with multimorbidity experience impaired quality of life, poor health and a burden from treatment. Their care is often disease-focused rather than patient-centred tailored to their individual needs. Objective To implement evaluate intervention improve the management patients in general practice. Design Pragmatic, cluster randomised controlled trial parallel process economic evaluations. Practices were centrally by statistician blind practice identifiers, using...
Background: Previous research has demonstrated how the Internet can foster emotional support and provide a ‘private’ space for discussing sensitive issues. Whilst family been located as primary source of support, empirical on dynamics close personal relationships in chronic illness experience remains challenge. Objective: To explore role supporting self-care nature social exchanged within an online self-management training course. Methods: Qualitative thematic narrative analysis discussion...
Objective Patients with multiple chronic health conditions are often managed in a disjointed fashion primary care, annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of 3D intervention, which was developed improve system care. Design Economic evaluation conducted alongside pragmatic cluster-randomised trial. Setting General practices three centres England and Scotland. Participants 797 adults or more were randomised...
Improving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised importance early identification and active management chronic kidney (CKD) in primary order to maintain health. However, awareness stage 3 CKD amongst remains limited. We aimed identify predictors patient self-report inform tailoring conversations around diverse populations. conducted cross-sectional analysis baseline data from 436 24 GP practices taking part randomised controlled...
Insomnia is a prevalent and distressing sleep disorder. Multicomponent cognitive-behavioural therapy the recommended first-line treatment, but access remains extremely limited, particularly in primary care where insomnia managed. One principal component of behavioural treatment called restriction therapy, which could potentially be delivered as brief single-component intervention by generalists care.