Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/31381
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dc.contributor.authorMercer, Stewart Wen_UK
dc.contributor.authorFitzpatrick, Bridieen_UK
dc.contributor.authorGuthrie, Bruceen_UK
dc.contributor.authorFenwick, Elisabethen_UK
dc.contributor.authorGrieve, Eleanoren_UK
dc.contributor.authorLawson, Kennyen_UK
dc.contributor.authorBoyer, Nickien_UK
dc.contributor.authorMcConnachie, Alexen_UK
dc.contributor.authorLloyd, Suzanne Men_UK
dc.contributor.authorO’Brien, Rosaleenen_UK
dc.contributor.authorWatt, Graham C Men_UK
dc.contributor.authorWyke, Sallyen_UK
dc.date.accessioned2020-07-04T00:01:44Z-
dc.date.available2020-07-04T00:01:44Z-
dc.date.issued2016-12en_UK
dc.identifier.other88en_UK
dc.identifier.urihttp://hdl.handle.net/1893/31381-
dc.description.abstractBackground Multimorbidity is common in deprived communities and reduces quality of life. Our aim was to evaluate a whole-system primary care-based complex intervention, called CARE Plus, to improve quality of life in multimorbid patients living in areas of very high deprivation. Methods We used a phase 2 exploratory cluster randomised controlled trial with eight general practices in Glasgow in very deprived areas that involved multimorbid patients aged 30–65 years. The intervention comprised structured longer consultations, relationship continuity, practitioner support, and self-management support. Control practices continued treatment as usual. Primary outcomes were quality of life (EQ-5D-5L utility scores) and well-being (W-BQ12; 3 domains). Cost-effectiveness from a health service perspective, engagement, and retention were assessed. Recruitment and baseline measurements occurred prior to randomisation. Blinding post-randomisation was not possible but outcome measurement and analysis were masked. Analyses were by intention to treat. Results Of 76 eligible practices contacted, 12 accepted, and eight were selected, randomised and participated for the duration of the trial. Of 225 eligible patients, 152 (68 %) participated and 67/76 (88 %) in each arm completed the 12-month assessment. Two patients died in the control group. CARE Plus significantly improved one domain of well-being (negative well-being), with an effect size of 0.33 (95 % confidence interval [CI] 0.11–0.55) at 12 months (p = 0.0036). Positive well-being, energy, and general well-being (the combined score of the three components) were not significantly influenced by the intervention at 12 months. EQ-5D-5L area under the curve over the 12 months was higher in the CARE Plus group (p = 0.002). The incremental cost in the CARE Plus group was £929 (95 % CI: £86–£1788) per participant with a gain in quality-adjusted life years of 0.076 (95 % CI: 0.028–0.124) over the 12 months of the trial, resulting in a cost-effectiveness ratio of £12,224 per quality-adjusted life year gained. Modelling suggested that cost-effectiveness would continue. Conclusions It is feasible to conduct a high-quality cluster randomised control trial of a complex intervention with multimorbid patients in primary care in areas of very high deprivation. Enhancing primary care through a whole-system approach may be a cost-effective way to protect quality of life for multimorbid patients in deprived areas. Trial registration Trial registration: ISRCTN 34092919, assigned 14/1/2013.en_UK
dc.language.isoenen_UK
dc.publisherSpringer Science and Business Media LLCen_UK
dc.relationMercer SW, Fitzpatrick B, Guthrie B, Fenwick E, Grieve E, Lawson K, Boyer N, McConnachie A, Lloyd SM, O’Brien R, Watt GCM & Wyke S (2016) The CARE Plus study – a whole-system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis. BMC Medicine, 14 (1), Art. No.: 88. https://doi.org/10.1186/s12916-016-0634-2en_UK
dc.rightsThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_UK
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_UK
dc.subjectMultimorbidityen_UK
dc.subjectPrimary careen_UK
dc.subjectDeprivationen_UK
dc.subjectSocioeconomicen_UK
dc.subjectGeneral practiceen_UK
dc.subjectLonger consultationsen_UK
dc.subjectCare planen_UK
dc.subjectMindfulnessen_UK
dc.subjectEmpathyen_UK
dc.subjectComplex interventionen_UK
dc.titleThe CARE Plus study – a whole-system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysisen_UK
dc.typeJournal Articleen_UK
dc.identifier.doi10.1186/s12916-016-0634-2en_UK
dc.identifier.pmid27328975en_UK
dc.citation.jtitleBMC Medicineen_UK
dc.citation.issn1741-7015en_UK
dc.citation.volume14en_UK
dc.citation.issue1en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.funderCSO Chief Scientist Officeen_UK
dc.citation.date22/06/2016en_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationGlasgow Caledonian Universityen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.identifier.isiWOS:000378676600001en_UK
dc.identifier.scopusid2-s2.0-84979030681en_UK
dc.identifier.wtid1504706en_UK
dc.date.accepted2016-06-02en_UK
dc.date.filedepositdate2020-07-03en_UK
dc.relation.funderprojectLiving well with multiple morbidity: the development and evaluation of a primary care-based complex intervention to support patients with multiple morbiditiesen_UK
dc.relation.funderrefARPG/07/1en_UK
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