Chronic Disease

Chronic disease self-management program improves illness management for up to 6 months, then effectiveness wanes

One-on-one and group sessions led by peers are a means of teaching individuals how to cope with their chronic diseases, such as arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and diabetes. A new study finds that individualized sessions in the patient's home bring only moderate, short-term improvements in chronic illness management self-efficacy, with no improvements in mental or physical health status or preventable hospitalizations. These findings raise questions about whether health care systems should spend limited resources on such programs, assert Anthony Jerant, M.D., of the University of California, Davis, and colleagues. They recruited 415 patients with chronic illnesses in Northern California to participate in 6 sessions with a peer, either by phone (139 patients) or in person (138 patients). Compared with those receiving usual care (138 patients), participants in the in-home, peer-led sessions had higher illness management self-efficacy at 6 weeks and 6 months, but at the 1-year mark these advances disappeared.

What's more, individuals did not improve their scores on physical and mental health status measures, and participating had no effect on hospitalizations or health care expenses. Telephone delivery of the peer intervention had no more benefits than usual care. The authors note that their findings are similar to those of a 2007 Cochrane systematic review of 17 randomized controlled trials of peer-led illness self-management programs delivered to individuals or groups of patients. They suggest that these findings question the cost-effectiveness of the peer-led approach to improving chronic illness outcomes, which has been suggested as a key element in redesign of the U.S. health care delivery system. The study was funded in part by the Agency for Healthcare Research and Quality (HS13603). See “Home-based, peer-led chronic illness self-management training: Findings from a 1-year randomized controlled trial,” by Dr. Jerant, Monique Moore-Hill, M.S., and Peter Franks, M.D., in the July/August 2009 Annals of Family Medicine 7(4), pp. 319-327.

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