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Research ArticleORIGINAL RESEARCH

A Virtual Community of Practice to Improve Primary Health Care Professionals’ Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial

Carola Orrego, Lilisbeth Perestelo-Pérez, Ana Isabel González-González, Marta Ballester-Santiago, Débora Koatz, Valeria Pacheco-Huergo, Amado Rivero-Santana, Vanesa Ramos-García, Nuria Mora Fernández, Alezandra Torres-Castaño and Carlos Bermejo-Caja
The Annals of Family Medicine May 2022, 20 (3) 204-210; DOI: https://doi.org/10.1370/afm.2799
Carola Orrego
1Avedis Donabedian Research Institute (FAD), Barcelona, Spain
2Universitat Autònoma de Barcelona, Barcelona, Spain
3Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
PhD
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  • For correspondence: corrego@fadq.org
Lilisbeth Perestelo-Pérez
3Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
4Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
PhD
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Ana Isabel González-González
3Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
5Institute of General Practice, Goethe University, Frankfurt, Germany
6Subdirección General de Investigación Sanitaria y Documentación, Dirección General Investigación, Docencia y Documentación, Consejería de Sanidad, Madrid, Spain
MD, PhD
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Marta Ballester-Santiago
1Avedis Donabedian Research Institute (FAD), Barcelona, Spain
2Universitat Autònoma de Barcelona, Barcelona, Spain
3Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
MSc
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Débora Koatz
1Avedis Donabedian Research Institute (FAD), Barcelona, Spain
2Universitat Autònoma de Barcelona, Barcelona, Spain
3Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
MSc
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Valeria Pacheco-Huergo
1Avedis Donabedian Research Institute (FAD), Barcelona, Spain
7Centro de Atención Primaria Turó, Instituto Catalán de la Salud, Barcelona, Spain
MD, PhD
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Amado Rivero-Santana
4Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
8Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
PhD
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Vanesa Ramos-García
8Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
MPsych
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Nuria Mora Fernández
1Avedis Donabedian Research Institute (FAD), Barcelona, Spain
2Universitat Autònoma de Barcelona, Barcelona, Spain
MSc
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Alezandra Torres-Castaño
8Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
PhD
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Carlos Bermejo-Caja
9Unidad de Apoyo Técnico, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
10Departamento Enfermería, Universidad Autónoma de Madrid, Spain
MSc
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    Figure 1.

    CONSORT flow diagram.

    CONSORT = Consolidated Standards of Reporting Trials; HCP = health care professional.

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    Table 1.

    Baseline Characteristics of Health Care Professionals

    Total
    (N = 321)
    Intervention
    (n = 183)
    Control
    (n = 138)
    Nurses, No. (%)131 (40.8)  83 (45.4)  48 (34.8)
    Age, y, mean (SD)  47.7 (8.79)  47.1 (8.78)  48.5 (8.77)
    Female, No. (%)243 (75.7)141 (77.0)102 (73.9)
    Years of experience, mean (SD)  22.0 (8.84)  21.9 (8.52)  22.1 (9.29)
    Years in primary care, mean (SD)  17.7 (8.92)  17.6 (8.67)  17.8 (9.29)
    Daily patient caseload number, mean (SD)  29.4 (11.3)  27.8 (10.7)  31.4 (11.8)
    • View popup
    Table 2.

    Baseline Characteristics of Patients

    Total
    (N = 1,921)
    Intervention
    (n = 1,095)
    Control
    (n = 826)
    Age, y, mean (SD)64.7 (12.4)64.7 (12.4)64.6 (12.3)
    Female, n (%)975 (50.8)524 (47.9)451 (54.6)
    Educational level, No. (%)
        None38 (2.0)25 (2.3)13 (1.6)
        Primary1,014 (52.8)551 (50.3)463 (56.1)
        Secondary558 (29.0)337 (30.8)221 (26.8)
        University311 (16.2)182 (16.6)129 (15.6)
    Marital status, No. (%)
        Single144 (7.5)78 (7.1)66 (8.0)
        Married/partner1,362 (70.9)797 (72.8)565 (68.4)
        Separated56 (2.9)26 (2.4)30 (3.6)
        Divorced129 (6.7)69 (6.3)60 (7.3)
        Widowed230 (12.0)125 (11.4)105 (12.7)
    Living alone, No. (%)304 (15.8)165 (15.1)139 (16.8)
    Born outside Spain, No. (%)171 (8.9)111 (10.1)60 (7.3)
    Chronic conditions, No. (%)
        Hypertension1,406 (73.2)799 (73.0)607 (73.5)
        Diabetes707 (36.8)425 (38.8)282 (34.1)
        Hypercholesterolemia1,122 (58.4)634 (57.9)488 (59.1)
        Ischemic heart disease155 (8.1)88 (8.0)67 (8.1)
        Heart failure220 (11.5)127 (11.6)93 (11.3)
        Cerebrovascular disease95 (4.9)54 (4.9)41 (5.0)
        Chronic obstructive pulmonary disease174 (9.1)111 (10.1)63 (7.6)
        Asthma168 (8.7)88 (8.0)80 (9.7)
        Chronic renal disease168 (8.7)93 (8.5)75 (9.1)
        Obesity667 (34.7)348 (31.8)319 (38.6)
    Duration of main disease, y, mean (SD)11.7 (7.4)11.5 (7.3)11.9 (7.5)
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    Table 3.

    Effectiveness of Intervention

    Health Care ProfessionalsCompleters Analysis (n = 253, k= 62)MI Analysis (n = 321, k = 63)BOCF Analysis (n = 321, k = 63)
    Intervention
    (n = 134, k = 31)
    Control
    (n = 119, k = 31)
    β (95% CI)
    P Valuea
    Intervention
    (n = 183, k = 31)
    Control
    (n = 138, k = 32)
    β (95% Cl)
    P Valuea
    Intervention (n = 183, k= 31)Control (n = 138, k = 32)β (95% CI) P Valuea
    Total PPOS score0.150.140.09
        Baseline4.43 (0.55)4.44 (0.54)(0.04 to 0.27)4.37 (0.55)4.44 (0.53)(0.03 to 0.25)4.37 (0.55)4.44 (0.53)(0 to 0.18)
        12 months4.65 (0.56)4.50 (0.54)P = .0074.60 (0.66)4.49 (0.57)P = .0114.53 (0.58)4.49 (0.53)P = .063
    PPOS Sharing subscale score0.290.30.18
        Baseline3.98 (0.71)3.95 (0.73)(0.14 to 0.44)3.91 (0.73)3.94 (0.73)(0.15 to 0.44)3.91 (0.73)3.94 (0.73)(0.06 to 0.31)
        12 months4.32 (0.71)4.00 (0.74)P <.0014.28 (0.76)3.99 (0.8)P <.0014.16 (0.77)3.99 (0.73)P = .004
    PPOS Caring subscale score0.01–0.02–0.01
        Baseline4.88 (0.51)4.94 (0.55)(–0.11 to 0.13)4.83 (0.54)4.93 (0.53)(–0.15 to 0.11)4.83 (0.54)4.93 (0.53)(–0.11 to 0.09)
      12 months4.99 (0.58)5.00 (0.51)P = .8694.93 (0.77)4.99 (0.53)P = .7694.91 (0.6)4.98 (0.5)P = .82
    PatientsCompleters Analysis (n = 1,442, k = 61)Ml Analysis (n = 1,921, k = 63)
    Intervention
    (n = 764, k= 30)
    Control
    (n = 678, k= 31)
    β (95% CI)
    P Valueb
    lntervention
    (n = 1,095, k = 31)
    Control
    (n = 826, k= 32)
    β (95% Cl)
    P Valueb
    PAM1.50.24
        Baseline65.6 (15.6)65.2 (16.2) (–1.53 to 4.53)65.6 (15.5)65.3 (16.4)(–2.28 to 2.76)
        12 months65.7 (15.4)64.8 (15.2)P = .33165.6 (17.5)65.0 (16.1)P = .852
    • BOCF = baseline observation carried forward; k = No. of primary care practices; MI = multiple imputation; PAM = Patient Activation Measure; PPOS = Patient-Practitioner Orientation Scale.

    • Note: Data for the intervention and control groups are presented as mean (SD).

    • ↵a Unstandardized coefficients (95% CI) and P value from multilevel linear regression models, with PPOS scores at 12 months as the dependent variable, fixed effects for health care professionals, and random effects for primary care practice (k), with adjustment for the profession (nurse or physician), patients attended per day, and baseline PPOS scores.

    • ↵b Unstandardized coefficients (95% CI) and P value from multilevel linear regression models, with PAM scores at 12 months as the dependent variable, fixed effects for patients, and random effects for professional and primary care practice (k), with adjustment for the rate of obesity and baseline PAM scores.

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  • VISUAL ABSTRACT IN PNG FILE BELOW

    • Orrego.png -

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The Annals of Family Medicine: 20 (3)
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A Virtual Community of Practice to Improve Primary Health Care Professionals’ Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial
Carola Orrego, Lilisbeth Perestelo-Pérez, Ana Isabel González-González, Marta Ballester-Santiago, Débora Koatz, Valeria Pacheco-Huergo, Amado Rivero-Santana, Vanesa Ramos-García, Nuria Mora Fernández, Alezandra Torres-Castaño, Carlos Bermejo-Caja
The Annals of Family Medicine May 2022, 20 (3) 204-210; DOI: 10.1370/afm.2799

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A Virtual Community of Practice to Improve Primary Health Care Professionals’ Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial
Carola Orrego, Lilisbeth Perestelo-Pérez, Ana Isabel González-González, Marta Ballester-Santiago, Débora Koatz, Valeria Pacheco-Huergo, Amado Rivero-Santana, Vanesa Ramos-García, Nuria Mora Fernández, Alezandra Torres-Castaño, Carlos Bermejo-Caja
The Annals of Family Medicine May 2022, 20 (3) 204-210; DOI: 10.1370/afm.2799
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