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Conference Abstracts

Proactive Health Support – a randomized controlled trial of telephone-based self-management support for persons at risk of hospital admission

Authors:

Kirstine Benthien ,

Center For Clinical Research And Prevention, Frederiksberg University, Denmark, DK
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Annemien Haveman-Nies,

Center For Clinical Research And Prevention, Frederiksberg University, Denmark, DK
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Emely de Vet

Center For Clinical Research And Prevention, Frederiksberg University, Denmark, DK
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Abstract

Introduction: The most burdened persons who are frequent hospital users are characterized by chronic diseases, multimorbidity, low socio-economic status, and higher age. These persons have complex care needs and their burden of disease and healthcare tasks may exceed their resources and self-management skills. When unmet, complex care needs may lead to unplanned hospital admissions. Hospital admissions are associated with bed availability and quality of primary care and therefore indicate lapses in preventive and proactive healthcare. Self-management support is developed to educate and support patients’ in managing chronic disease, but the evidence base of telephone-based interventions is poor with mixed results.

Aims and methods: This study evaluates Proactive Health Support (PaHS) in a national randomized controlled trial. Participants were at risk of emergency hospital admissions with 1. chronic diseases, 2. ≥ three unplanned hospital contacts, or 3. age ≥ 65 years with a preventable hospital admission. The intervention was an addition to usual care and began with a physical start-up session followed by telephone sessions to support self-management focusing on knowledge, coping, self-care, and healthcare across sectors. The two co-primary outcomes were HRQoL (Mental Health Component Summary Score of SF36v2) analyzed with mixed models and hospital admissions analyzed with poisson regression at 6 months.

Results: During the study period, 6402 persons were randomized. HRQoL was significantly improved at 6 months (Est. 1.4992, p= <.0001) and at three and 12 months on all 10 scales. There was no effect of the PaHS intervention on hospital admissions at six months with an adjusted estimate of 0.0074 (p= 0.8691). Instead, the intervention seemed to increase the use of primary healthcare services including psychologists and anxiety medication.

Conclusions: The PaHS intervention improved HRQoL, did not prevent hospital admissions but seemed to increase the use of primary healthcare services.

Implications: Participants were included as subjects, exploring their experiences as well as patient-reported outcomes. With few dropouts the intervention was acceptable for participants. To promote transferability the method of inclusion needs further development due to legal restrictions in using predictive models.

 

How to Cite: Benthien K, Haveman-Nies A, de Vet E. Proactive Health Support – a randomized controlled trial of telephone-based self-management support for persons at risk of hospital admission. International Journal of Integrated Care. 2022;22(S3):230. DOI: http://doi.org/10.5334/ijic.ICIC22111
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Published on 04 Nov 2022.

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