Blakeman, Tom, Blickem, Christian, Kennedy, Anne P., Reeves, Davd, Bower, Peter, Gaffney, Hannah, Gardner, Caroline, Lee, Victoria, Jariwala, Praksha, Dawson, Shoba, Mossabir, Rahena, Brooks, Helen, Richardson, Gerry, Spackman, Eldon, Vassilev, Ivaylo, Chew-Graham, Carolyn and Rogers, Anne (2014) Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial. PLoS ONE, 9 (10), 1-15, [e109135]. (doi:10.1371/journal.pone.0109135).
Abstract
Background
Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.
Methods and Findings
In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.
Conclusions
An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.
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