Cost-effectiveness of an occupational therapy-led self-management support programme for multimorbidity in primary care.

BACKGROUND: Multimorbidity is a major public health concern. Complex interventions, incorporating individualized care plans, may be appropriate for patients with multimorbidity given their individualized and variable needs. There is a dearth of evidence on the cost-effectiveness of complex multimorbidity interventions. OBJECTIVE: This study examines the cost-effectiveness of a 6-week occupational therapy-led self-management support programme (OPTIMAL) for adults with multimorbidity. METHODS: Economic evaluation, from a healthcare perspective, was conducted alongside a randomized controlled trial of 149 adults with multimorbidity. Intervention was the OPTIMAL programme with a comparison of usual primary care. Incremental costs, quality-adjusted life years (QALYs) gained, and expected cost-effectiveness were estimated at 6 months and uncertainty was explored using cost-effectiveness acceptability curves. RESULTS: The intervention was associated with a mean improvement in QALYs gained of 0.031 per patient (P-value: 0.063; 95% confidence intervals [CIs]: -0.002 to 0.063) and a mean reduction in total costs of €2,548 (P-value: 0.114; 95% CIs: -5,606 to 509) per patient. At cost-effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of the intervention being cost-effective was estimated to be 0.951 and 0.958, respectively. The results remained consistent across all subgroups examined. CONCLUSIONS: This study adds to the limited evidence base on the cost-effectiveness of complex interventions for multimorbidity, and highlights the potential for the OPTIMAL programme to be cost-effective. Further studies are warranted to explore the clinical and cost-effectiveness of complex interventions for the multimorbidity patient population, and for subgroups within it. TRIAL REGISTRATION: Trial number: ISRCTN67235963.

Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial.

BACKGROUND: Effective primary care interventions for multimorbidity are needed. AIM: To evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity. DESIGN AND SETTING: A pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison. METHOD: Primary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further. RESULTS: A total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = -0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = -0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit. CONCLUSION: OPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.

Impact of Fatigue in Rheumatic Diseases in the Work Environment: A Qualitative Study.

Fatigue is a symptom of arthritis that causes difficulty at work. An improved understanding of this symptom could assist its management in the work environment. The aim of this study was to explore people with rheumatic diseases' experiences of fatigue in work. A qualitative descriptive design was used with semi-structured interviews and a constant comparative method of data analysis. There were 18 participants, the majority of them female with Rheumatoid Arthritis (RA) and working full-time. Three themes were identified: "Impact of fatigue on work performance" with cognition, mood and physical abilities being the main difficulties reported. In the second theme "Disclosure at Work" participants discussed disclosing their disease to employers but reported a lack of understanding of fatigue from colleagues. The final theme "work-based fatigue management strategies" included cognitive strategies and energy management techniques, which were mainly self-taught. In this study, fatigue was reported to impact on many areas of work performance with limited understanding from colleagues and employers. Interventions from health professionals to assist with development of work-related self-management skills are required to assist with symptom management in the work place. Such interventions should include education to employers and colleagues on the nature of fatigue in Rheumatic diseases.

Impact of an occupation-based self-management programme on chronic disease management.

INTRODUCTION: There is a need for the development and evaluation of occupational therapy interventions enabling participation and contributing to self-management for individuals with multiple chronic conditions. This pilot study aimed to assess the feasibility and potential impact of an occupation-based self-management programme for community living individuals with multiple chronic conditions. METHODS: Sixteen participants completed a six-week programme. Assessments were conducted at baseline, immediately post-intervention and at eight-week follow-up. Sixteen participants provided immediate follow-up data and 15 participants provided eight-week follow-up data. Outcome measures included participation in occupations; perceptions of occupational performance and satisfaction; self-efficacy; depression, anxiety and quality of life. Focus groups explored participants' perceptions of the programme. RESULTS: The findings are promising and indicate that the programme delivery was feasible. Significant differences were found immediately post-intervention in frequency of activity participation (P = 0.008), including domestic (P = 0.040) and work/leisure activities (P = 0.015), self-perceptions of occupational performance (P = 0.017) and satisfaction with same (P = 0.023). At eight-week follow-up, significant differences continued to be found in frequency of activity participation (P = 0.018), including work/leisure activities (P = 0.038), perceptions of occupational performance (P = 0.010) and satisfaction (P = 0.008) and self-efficacy (P = 0.050). No differences were found in anxiety, depression or quality of life at follow-up periods. Focus group data supported the programme's impact on activity participation and self-efficacy. CONCLUSION: Despite the small sample in this pilot study there were significant improvements in occupational performance and the findings provide support for the programme. However, there is a need to test the intervention rigorously with a definitive randomised trial in a primary care setting.