Effectiveness of community-links practitioners in areas of high socioeconomic deprivation

Mercer, S. W. , Fitzpatrick, B., Grant, L., Chng, N. R. , McConnachie, A. , Bakhshi, A., James-Rae, G., O'Donnell, C. A. and Wyke, S. (2019) Effectiveness of community-links practitioners in areas of high socioeconomic deprivation. Annals of Family Medicine, 17(6), pp. 518-525. (doi:10.1370/afm.2429) (PMID:31712290)

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Abstract

PURPOSE: To assess the effect of a primary care–based community-links practitioner (CLP) intervention on patients’ quality of life and well-being. METHODS: Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. Primary outcome: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). Secondary outcomes: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked. RESULTS: Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources. CONCLUSIONS: We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.

Item Type:Articles
Additional Information:This study was funded by the NHS Health Scotland (contract 66450/1, 13/08/2014).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wyke, Professor Sally and McConnachie, Professor Alex and James-Rae, Mr Greg and Grant, Mrs Lesley and Fitzpatrick, Dr Bridie and Mercer, Professor Stewart and Bakhshi, Mrs Andisheh and Chng, Dr Nai Rui and O'Donnell, Professor Kate
Authors: Mercer, S. W., Fitzpatrick, B., Grant, L., Chng, N. R., McConnachie, A., Bakhshi, A., James-Rae, G., O'Donnell, C. A., and Wyke, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Social Scientists working in Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Annals of Family Medicine
Publisher:Annals of Family Medicine
ISSN:1544-1709
ISSN (Online):1544-1717
Copyright Holders:Copyright © 2019 Annals of Family Medicine, Inc.
First Published:First published in Annals of Family Medicine 17(6):518-525
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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