Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure – A randomized controlled trial

RESEARCH ARTICLE Effects of a person-centred telephonesupport in patients with chronic obstructive pulmonary disease and/or chronic heart failure – A randomized controlled trial Andreas Fors1,2,3*, Elin Blanck1,2, Lilas Ali1,2, Ann Ekberg-Jansson4,5, Michael Fu6, Irma Lindström Kjellberg1,2, Åsa Mäkitalo7, Karl Swedberg2,6,8, Charles Taft1,2, Inger Ekman1,2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Fors A, Blanck E, Ali L, Ekberg-Jansson A, Fu M, Lindström Kjellberg I, et al. (2018) Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure – A randomized controlled trial. PLoS ONE 13(8): e0203031. https://doi.org/ 10.1371/journal.pone.0203031 Editor: Christophe Leroyer, Universite de Bretagne Occidentale, FRANCE 1 Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2 Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden, 3 Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden, 4 Department of Respiratory medicine and Allergology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 5 Research and Development department, Region Halland, Halmstad, Sweden, 6 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 7 Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden, 8 National Heart and Lung Institute, Imperial College, London, United Kingdom * Abstract Purpose To evaluate the effects of person-centred support via telephone in two chronically ill patient groups, chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF). Received: December 6, 2017 Accepted: August 7, 2018 Published: August 31, 2018 Copyright: © 2018 Fors et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by the Centre for Person-Centred Care at the University of Gothenburg (GPCC), Sweden. GPCC is funded by the Swedish Government’s grant for Strategic Research Areas, Care Sciences (Application to Swedish Research Council no. 2009-1088) (IE) and co-funded by the University of Gothenburg, Method 221 patients  50 years with COPD and/or CHF were randomized to usual care vs. usual care plus a person-centred telephone-support intervention and followed for six months. Patients in the intervention group were telephoned by a registered nurse initially to co-create a person-centred health plan with the patient and subsequently to discuss and evaluate the plan. The primary outcome measure was a composite score comprising General Self-Efficacy (GSE), re-hospitalization and death. Patients were classified as deteriorated if GSE had decreased by  5 points, or if they had been re-admitted to hospital for unscheduled reasons related to COPD and/or CHF or if they had died. Results At six-month follow-up no difference in the composite score was found between the two study groups (57.6%, n = 68 vs. 46.6%, n = 48; OR = 1.6, 95% CI: 0.9–2.7; P = 0.102) in the intention-to-treat analysis (n = 221); however, significantly more patients in the control group showed a clinically important decrease in GSE ( 5 units) (22.9%, n = 27 vs. 9.7%, n = 10; OR = 2.8, 95% CI: 1.3–6.0; P = 0.011). There were 49 clinical events (14 deaths, 35 re- PLOS ONE | https://doi.org/10.1371/journal.pone.0203031 August 31, 2018 1 / 12 Effects of a person-centred telephone-support in patients with COPD and/or CHF Sweden. The Swedish Research Council (DNr 5212013-2723) (IE), the Swedish agreement between the government and the county councils concerning economic support for providing an infrastructure for research and education of doctors (ALFGBG-444681) (IE), and Research and Development Unit, Primary Health Care, Region Västra Götaland also contributed to the funding of the study (AF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. admissions) in the control group and 41 in the intervention group (9 deaths, 32 re-admissions). Per-protocol analysis (n = 202) of the composite score showed that more patients deteriorated in the control group than in the intervention group (57.6%, n = 68 vs. 42.9%, n = 36; OR = 1.8, 95% CI 1.0–3.2; P = 0.039). Conclusion Person-centred support via telephone mitigates worsening self-efficacy without increasing the risk of clinical events in chronically ill patients with CHF and/or COPD. This indicates that a patient-healthcare professional partnership may be established without the need for face-to-face consultations, even in vulnerable patient groups. Trial registration ISRCTN.com ISRCTN55562827. 1. Introduction Person-centred care (PCC) constitutes a shift away from a one-size-fits-all model of care based on diagnoses to an approach based on ethical principles where a contractual agreement is made involving the patient as an active partner in the care and decision-making process [1, 2]. In the PCC framework developed by the University of Gothenburg Centre for Person-Centred Care (GPCC), patients and healthcare professionals jointly develop a health plan based on the patient´s illness history and medical status in which the patient’s own capabilities and social support resources are identified and documented along with potential barriers to achieve goals [1]. Our point of departure is that health care needs to target patients’ beliefs in their ability to perform desired activities rather than simply attempting to convince them of the value of certain activities [3]. A crucial concept in this regard is self-efficacy, which is defined as a person’s belief in his/her own ability to successfully execute behaviours necessary to produce desired outcomes [4]. Accordingly, a central goal in the GPCC approach is to enable patients’ self-efficacy by stressing the importance of knowing the patient as a person with capabilities and resources to perform activities and achieve desired goals [1]. The effectiveness of PCC as a tool to improve health care has been demonstrated in several controlled trials in different conditions, settings and contexts. For example, in chronic conditions such as chronic heart failure (CHF), PCC has been shown to reduce length of hospital stay [5]; reduce uncertainty about the disease [6] and treatment and improve the efficiency of the discharge process [7]; lower healthcare costs [8, 9]; reduce re-hos (...truncated)