SACRAMENTO -- A peer-led health education and counseling program designed to help patients manage their chronic illnesses initially had some positive outcomes but did not improve patient health after one year, according to new research from UC Davis.
Anthony Jerant, UC Davis associate professor of family and community medicine, initiated the study -- published in the July/August issue of the Annals of Family Medicine -- because he sees the devastating physical and mental effects that diabetes, asthma, heart disease and other chronic conditions have on patients. In addition to significant personal costs, chronic illnesses account for 70 percent of all deaths in the United States and represent more than 75 percent of the nation's $2 trillion medical-care costs.
"These are tough diseases that require a patient's daily attention in order to manage them properly," said Jerant. "Patients often have to take multiple medications, follow special diets, exercise and cope with physical and emotional symptoms. It's ongoing work, and most people could use some help."
Interested in options, he was intrigued by the idea of chronic-disease interventions led by trained peers -- non-medical personnel who themselves have experiences with chronic conditions. Prior studies of such programs showed that they can improve patients' health status and, in some cases, reduce hospital visits. The effects, however, were modest. The programs also were tested only over a six-month period -- a time frame Jerant considered too short for conditions that are long-term and recurrent.
To find out if one of these interventions could translate into positive and more powerful health effects for a longer period of time, Jerant and his colleagues developed Homing in on Health -- a home-delivered version of Stanford's Chronic Disease Self-Management Program -- and tested its impact on improving patients' confidence levels and abilities to manage their health conditions for one year. The home-based program was designed for patients with limitations that made traveling to group classes difficult, or who were uncomfortable in group situations.
The study included 415 Northern California patients with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, clinical depression or diabetes who were linked with specially trained peers to address topics such as exercising safely, coping with difficult emotions and managing symptoms. Patients received sessions either by phone or at home six times over the course of a year, and researchers surveyed patients quarterly about their health status and confidence with illness management. They also tracked participants' health-care expenditures and hospital visits. The Homing in on Health program outcomes were compared with outcomes for patients who received regular health care with no alternative interventions.
"When compared with usual care, the telephone intervention was not more effective at all," Jerant said. "The in-home approach was beneficial in improving confidence to manage illnesses for six months, but at one year this benefit had gone away. At the end of the study, Homing in on Health did not lead to better health status or reduced hospitalizations."
That being said, Jerant believes self-management programs do have some benefits.
"Participants told us they enjoyed both the phone and in-home training, so there were some personal benefits," he said. "The key question our findings raise is whether health-care systems should spend limited resources on these types of outreach programs when they don't improve mental or physical health status or reduce preventable hospitalizations."
More recently, Jerant has been working with UC Davis School of Medicine colleagues on training physicians to communicate in ways that bolster patients' confidence in managing their health conditions.
"The physician-patient relationship is very powerful, and perhaps could be leveraged to improve health outcomes more significantly than peer-led approaches," he explained. "Physicians have great potential to inspire and motivate patients."
Initial testing of the training among resident physicians showed that it did change communication behaviors, so the approach so far seems promising.
"The next steps are to explore its utility with practicing physicians and to see whether it changes patient health behaviors and outcomes," Jerant said.
Jerant's UC Davis colleagues on "Home-Based, Peer-Led Chronic Illness Self Management Training: Findings from a One-Year Randomized Controlled Trial" were Monique Moore-Hill, project manager, and Peter Franks, professor of community and family medicine. Their research was funded in part by a grant from the Agency for Healthcare Research and Quality.
The UC Davis Department of Family and Community Medicine provides ongoing, comprehensive, compassionate and personal care for patients within the context of family and community. The medical team integrates a humanistic approach to treating the "whole person" with evidence-based care. Special areas of faculty research are health-behavior change, physician-patient communication, chronic-illness care, women's health issues, and reducing racial and ethnic health disparities. For more information, visit the UC Davis Department of Family and Community Medicine Benefits .