A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease
Open accessAbstract
OBJECTIVES: We developed a patient centred approach to chronic disease self management by providing information designed to promote patient choice. We then conducted a randomised controlled trial of the approach in inflammatory bowel disease (IBD) to assess whether it could alter clinical outcome and affect health service use. DESIGN: A multicentre cluster randomised controlled trial. SETTING: The trial was conducted in the outpatient departments of 19 hospitals with randomisation by treatment centre, 10 control sites, and nine intervention sites. For patients at intervention sites, an individual self management plan was negotiated and written information provided. PARTICIPANTS: A total of 700 patients with established inflammatory bowel disease were recruited. MAIN OUTCOME MEASURES: Main outcome measures recorded at one year were: quality of life, health service resource use, and patient satisfaction. Secondary outcomes included measures of enablement-confidence to cope with the condition. RESULTS: One year following the intervention, self managing patients had made fewer hospital visits (difference -1.04 (95% confidence interval (CI) -1.43 to -0.65); p<0.001) without increase in the number of primary care visits, and quality of life was maintained without evidence of anxiety about the programme. The two groups were similar with respect to satisfaction with consultations. Immediately after the initial consultation, those who had undergone self management training reported greater confidence in being able to cope with their condition (difference 0.90 (95% CI 0.12-1.68); p<0.03). CONCLUSIONS: Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control.
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Only five out of the 22 cluster-randomized studies had the ICC reported.
“Notably, only five (Chenoweth 2009; Kennedy 2004; Kinmonth 1998; Krones 2008; Loh 2007) out of the 22 studies had the ICC reported.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Kennedy 2004
In Kennedy 2004, there was no difference in quality of life.
“The intervention patients in Kennedy 2004 reportedly had a higher number of relapses, but there was no difference in depression, anxiety, or quality of life.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Kennedy 2004
In Kennedy 2004, there was no difference in anxiety.
“The intervention patients in Kennedy 2004 reportedly had a higher number of relapses, but there was no difference in depression, anxiety, or quality of life.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Kennedy 2004
In Kennedy 2004, there was no difference in depression.
“The intervention patients in Kennedy 2004 reportedly had a higher number of relapses, but there was no difference in depression, anxiety, or quality of life.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Kennedy 2004
In Kennedy 2004, intervention patients reportedly had a higher number of relapses.
“The intervention patients in Kennedy 2004 reportedly had a higher number of relapses, but there was no difference in depression, anxiety, or quality of life.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Kennedy 2004
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Bandura, A., Ritter, P., Gonzalez, V. M., Laurent, D. D., & Holman, H. R. (1999) · Medical Care · doi:10.1097/00005650-199901000-00003 · Cited by 2,261 · see citing works
Patient-Centered Medicine: Transforming the Clinical Method
Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. (1995) · Cited by 1,299 · see citing works
A New Measure of Health Status for Clinical Trials in Inflammatory Bowel Disease
Guyatt, G., Mitchell, A., Irvine, E. J., Singer, J., Williams, N., Goodacre, R. L., & Tompkins, C. (1989) · Gastroenterology · doi:10.1016/s0016-5085(89)80080-0 · Cited by 1,289 · see citing works
Patient-Centered Medicine: Transforming the Clinical Method
Schofield, T. (1995) · BMJ · doi:10.1136/bmj.311.7019.1580 · Cited by 878 · see citing works
Weingarten, S. R. (2002) · BMJ · doi:10.1136/bmj.325.7370.925 · Cited by 735 · see citing works
Sharing decisions with patients: is the information good enough?
Coulter, A., Entwistle, V. A., & Gilbert, D. (1999) · BMJ · doi:10.1136/bmj.318.7179.318 · Cited by 638 · see citing works
Quality at general practice consultations: cross sectional survey
Howie, J. G., Heaney, D., Maxwell, M., Walker, J. J., Freeman, G. K., & Rai, H. (1999) · BMJ · doi:10.1136/bmj.319.7212.738 · Cited by 362 · see citing works
Baker, R. (1990) · PubMed · Cited by 360 · see citing works
Mead, N., Bower, P., & Hann, M. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00171-x · Cited by 275 · see citing works
Writing wrongs? An analysis of published discourses about the use of patient information leaflets
Dixon‐Woods, M. (2001) · Social Science & Medicine · doi:10.1016/s0277-9536(00)00247-1 · Cited by 251 · see citing works
Stata User's Guide: Release 15.
StataCorp (2017) · Cited by 231 · see citing works
Guided self-management and patient-directed follow-up of ulcerative colitis: a randomised trial
Robinson, A., Thompson, D. G., Wilkin, D., & Roberts, C. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06105-0 · Cited by 218 · see citing works
Meeting the needs of chronically ill people
Wagner, E. H. (2001) · BMJ · doi:10.1136/bmj.323.7319.945 · Cited by 130 · see citing works
Borgaonkar, M. R., Townson, G., Donnelly, M., & Irvine, E. J. (2002) · Inflammatory Bowel Diseases · doi:10.1097/00054725-200207000-00005 · Cited by 102 · see citing works
Kennedy, A. P., Nelson, E. C., Reeves, D., Richardson, G. A., Roberts, C., Robinson, A., Rogers, A. E., Sculpher, M. J., & Thompson, D. (2003) · Health Technology Assessment · doi:10.3310/hta7280 · Cited by 95 · see citing works
Self-citationLahdensuo, A., Haahtela, T., Herrala, J., Kava, T., Kiviranta, K., Kuusisto, P., Pekurinen, M., Peramaki, E., Saarelainen, S., Svahn, T., et al. (1998) · BMJ · doi:10.1136/bmj.316.7138.1138 · Cited by 86 · see citing works
Kennedy, A. P., & Rogers, A. E. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00228-2 · Cited by 72 · see citing works
Self-citationA patient led NHS: managing demand at the interface between lay and primary care
Rogers, A., Entwistle, V. A., & Pencheon, D. (1998) · BMJ · doi:10.1136/bmj.316.7147.1816 · Cited by 54 · see citing works
Kennedy, A. P., Robinson, A., Hann, M., Thompson, D. G., & Wilkin, D. (2003) · Health & Social Care in the Community · doi:10.1046/j.1365-2524.2003.00399.x · Cited by 52 · see citing works
Self-citationImproving self-management skills: a whole systems approach
Kennedy, A. P., & Rogers, A. E. (2001) · British Journal of Nursing · doi:10.12968/bjon.2001.10.11.10435 · Cited by 45 · see citing works
Self-citationHospitals, F. D. (1981) · Lenus, The Irish Health Repository (Dr Steevens Hospital Library) · Cited by 43 · see citing works
Small Group Interactive Techniques Utilizing Videofeedback
Gask, L. (1998) · The International Journal of Psychiatry in Medicine · doi:10.2190/u8mm-jx7y-lt0t-rkpx · Cited by 38 · see citing works
Development of a guidebook to promote patient participation in the management of ulcerative colitis
Kennedy, A. P., Robinson, A. J., Thompson, D. G., et al. (1999) · Health & Social Care in the Community · doi:10.1046/j.1365-2524.1999.00174.x · Cited by 29 · see citing works
Self-citationPractice parameters for the treatment of mucosal ulcerative colitis—Supporting documentation
The Standards Practice Task Force The American Society of Colon and Rectal Surgeons (1997) · Diseases of the Colon & Rectum · doi:10.1007/bf02050809 · Cited by 25 · see citing works
Information for Patients about Inflammatory Bowel Disease
Mansfield, J. C., Tanner, A. R., & Bramble, M. G. (1997) · Journal of the Royal College of Physicians of London · doi:10.1016/s0035-8819(25)00237-5 · Cited by 23 · see citing works
Guided Self-Management and Patient-Directed Follow-up of Ulcerative Colitis: A Randomised Trial
Braegger, C. (2002) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/00005176-200204000-00026 · Cited by 13 · see citing works
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Lamb, C. A., Kennedy, N. A., Raine, T., Hendy, P. A., Smith, P. J., Limdi, J. K., Hayee, B., Lomer, M. C. E., Parkes, G. C., Selinger, C., et al. (2019) · Gut · doi:10.1136/gutjnl-2019-318484 · Cited by 2,346 · see citing works
Interventions for providers to promote a patient-centred approach in clinical consultations
Dwamena, F., Holmes-Rovner, M., Gaulden, C. M., Jorgenson, S., Sadigh, G., Sikorskii, A., Lewin, S., Smith, R. C., Coffey, J., Olomu, A., et al. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003267.pub2 · Cited by 1,227 · see citing works
Caprilli, R., Gassull, M. A., Escher, J. C., Moser, G., Munkholm, P., Forbes, A., Hommes, D. W., Lochs, H., Angelucci, E., Cocco, A., et al. (2006) · Gut · doi:10.1136/gut.2005.081950c · Cited by 428 · see citing works
Graff, L. A., Walker, J. R., Lix, L., Clara, I., Rawsthorne, P., Rogala, L., Miller, N., Jakul, L., McPhail, C., Ediger, J., et al. (2006) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2006.09.027 · Cited by 292 · see citing works
Kennedy, A., Bower, P., Reeves, D., Blakeman, T., Bowen, R., Chew-Graham, C., Eden, M., Fullwood, C., Gaffney, H., Gardner, C., et al. (2013) · BMJ · doi:10.1136/bmj.f2882 · Cited by 239 · see citing works
Self-citationPsychological interventions for treatment of inflammatory bowel disease
Timmer, A., Preiss, J. C., Motschall, E., Rücker, G., Jantschek, G., & Moser, G. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006913.pub2 · Cited by 187 · see citing works
Rogers, A., Kennedy, A., Nelson, E., & Robinson, A. (2005) · Qualitative Health Research · doi:10.1177/1049732304272048 · Cited by 162 · see citing works
Self-citationKennedy, A., Rogers, A., Chew-Graham, C., Blakeman, T., Bowen, R., Gardner, C., Lee, V., Morris, R., & Protheroe, J. (2014) · Implementation Science · doi:10.1186/s13012-014-0129-5 · Cited by 104 · see citing works
Self-citationPsychotherapy with chronic inflammatory bowel disease patients: A Review
von Wietersheim, J., & Kessler, H. (2006) · Inflammatory Bowel Diseases · doi:10.1097/01.mib.0000236925.87502.e0 · Cited by 103 · see citing works
Knowles, S. R., Monshat, K., & Castle, D. J. (2013) · Inflammatory Bowel Diseases · doi:10.1097/mib.0b013e318296ae5a · Cited by 102 · see citing works
Langhorst, J., Mueller, T., Luedtke, R., Franken, U., Paul, A., Michalsen, A., Schedlowski, M., Dobos, G. J., & Elsenbruch, S. (2007) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520601101682 · Cited by 94 · see citing works
Distance management of inflammatory bowel disease: systematic review and meta-analysis
Huang, V. W. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i3.829 · Cited by 75 · see citing works
Kennedy, A., Chew-Graham, C., Blakeman, T., Bowen, A., Gardner, C., Protheroe, J., Rogers, A., & Gask, L. (2010) · Implementation Science · doi:10.1186/1748-5908-5-7 · Cited by 66 · see citing works
Self-citationBerding, A., Witte, C., Gottschald, M., Kaltz, B., Weiland, R., Gerlich, C., Reusch, A., Kruis, W., & Faller, H. (2016) · Inflammatory Intestinal Diseases · doi:10.1159/000452989 · Cited by 42 · see citing works
Imbalance in the Stress-Adaptation System in Patients With Inflammatory Bowel Disease
Kuroki, T., Ohta, A., Sherriff-Tadano, R., Matsuura, E., Takashima, T., Iwakiri, R., & Fujimoto, K. (2011) · Biological Research For Nursing · doi:10.1177/1099800410388638 · Cited by 28 · see citing works
Self-help interventions in irritable bowel syndrome
Hungin, A. P. S. (2006) · Gut · doi:10.1136/gut.2005.075606 · Cited by 10 · see citing works
- Authors
- Kennedy, A. P.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Kennedy, A P
- ORCID
- Kennedy, A P
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2004-11-01
- Volume
- 53
- Issue
- 11
- Pages
- 1639-1645
- ISSN
- 0017-5749 (ISSN-L)
- PMC
- PMC1774266
- OpenAlex
- W2123485165
- Cited by
- 213
- References
- 28
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 12 · 2020: 12 · 2019: 6 · 2018: 5 · 2017: 7 · 2016: 9 · 2015: 11 · 2014: 15 · 2013: 13 · 2012: 11
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Gut (publishedVersion, other-oa)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- Health Technology Assessment Programme
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- inflammatory bowel disease, self-management, patient-centered care, self-management plans, health care utilization, hospital visits, quality of life, patient satisfaction, coping confidence, cost-effectiveness, chronic disease management
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Aged, Aged, 80 and over, Female, Health Resources, Humans, Male, Middle Aged, Outpatient Clinics, Hospital, Patient Acceptance of Health Care, Patient Education as Topic, Quality of Life, Recurrence, Self Care, Inflammatory Bowel Diseases, Treatment Outcome, Patient Satisfaction
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