JMIR Publications

ABSTRACT

Background:

Chronic obstructive pulmonary disorder (COPD) and chronic heart failure (CHF) are characterised by severe symptom burden and common acute worsening episodes often requiring hospitalisation and affect prognosis. Although many studies show that person-centred care (PCC) increases self-efficacy in patients with chronic conditions, studies in patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalisation in those patients are scarce.

Objective:

To evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF.

Methods:

Multicenter randomized trial from 2018 to 2020. From nine primary care centers, 222 patients were recruited. Patients with a diagnosis of COPD, CHF, or both, and internet access, were eligible. Participants were randomized into either usual care (n=112) or PCC combined with usual care (n=110). The intervention's main component was a personal health plan co-created by the participants and assigned health care professionals (HCPs). HCPs called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary endpoint, divided into two categories (improved and deteriorated/unchanged), was a composite score of change in general self-efficacy (GSE) and hospitalisation or death 6 months after randomisation. Data from the ITT-group at 3-month and 6-month follow-ups were analysed. In addition, per-protocol (PP) analysis was conducted of those participants who used the intervention.

Results:

No significant differences were found between the groups in the composite score at the 3- and 6-month follow-up. However, the PP analysis of the 3-month follow-up revealed a significant difference in the composite score between the study groups (P=.047), although it did not maintain to the end of follow-up at 6 months (P=.240). This effect was driven by a change in GSE from baseline.

Conclusions:

PCC, by a combined digital platform and structured telephone support, seems to be a safe option to increase the self-efficacy of people with CHF and COPD. This study adds to the knowledge of conceptual innovations in primary care to support patients with CHF and COPD. Clinical Trial: The trial was registered at ClinicalTrials.gov June 7, 2017, identifier: NCT03183817