PT  - JOURNAL ARTICLE
AU  - Fortin, Martin
AU  - Stewart, Moira
AU  - Ngangue, Patrice
AU  - Almirall, José
AU  - Bélanger, Mathieu
AU  - Brown, Judith Belle
AU  - Couture, Martine
AU  - Gallagher, Frances
AU  - Katz, Alan
AU  - Loignon, Christine
AU  - Ryan, Bridget L.
AU  - Sampalli, Tara
AU  - Wong, Sabrina T.
AU  - Zwarenstein, Merrick
TI  - Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial
AID  - 10.1370/afm.2650
DP  - 2021 Mar 01
TA  - The Annals of Family Medicine
PG  - 126--134
VI  - 19
IP  - 2
4099  - http://www.annfammed.org/content/19/2/126.short
4100  - http://www.annfammed.org/content/19/2/126.full
SO  - Ann Fam Med2021 Mar 01; 19
AB  - PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices.METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. Secondary outcomes: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals.RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results.CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.