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Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial

¹ Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California
² Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California

CORRESPONDING AUTHOR: Anthony Jerant, MD, Department of Family & Community Medicine University of California Davis School of Medicine 4860 Y Street, Suite 2300 Sacramento, CA 95817 afjerant{at}ucdavis.edu

PURPOSE Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. Limitations of most studies, however, include use of multiple outcome measures without predesignated primary outcomes and lack of randomized follow-up beyond 6 months. We conducted a 1-year randomized controlled trial of Homing in on Health (HIOH), a Chronic Disease Self-Management Program variant, addressing these limitations.

METHODS We randomized outpatients (N = 415) aged 40 years and older and who had 1 or more of 6 common chronic illnesses, plus functional impairment, to HIOH delivered in homes or by telephone for 6 weeks or to usual care. Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey‘s physical component (PCS-36) and mental component (MCS-36) summary scores. Secondary outcomes included the EuroQol EQ-5D and visual analog scale (EQ VAS), hospitalizations, and health care expenditures.

RESULTS Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks (effect size = 0.27; 95% CI, 0.10–0.43) and at 6 months (0.17; 95% CI, 0.01–0.33), but not at 1 year. In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome, the EQ VAS (1-year effect size = 0.40; CI, 0.14–0.66). HIOH delivered by telephone had no significant effects on any outcomes.

CONCLUSIONS Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies, in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization. These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.

Key Words: Chronic disease • self care • chronic disease self-management program • health status • randomized controlled trial • self-efficacy • qualitative research

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