Dilemmas surrounding implementation of expert patient programmes.
The findings of this study are contrary to the consistent evidence from other studies, but it is interesting to note that a similar study done in the primary care setting in United States also did not demonstrate significant clinical benefits(1).
Although this study was well designed, there are few issues that might have had a bearing on the outcome. Out of the 2891 patients approached, only 812 patients entered into the study. The patients who declined to participate in the study might have grounds that could have influenced the outcome. Although the patients were randomised by stratifying certain baseline characteristics, they have not been randomised for other important confounding factors like associated co-morbidities including obesity, alternative therapies, duration and stage of illness. This might have significantly skewed the result. This may also explain the observed lack of significant difference in the number of subsequent consultations with the general practitioners. It might also have been of interest to consider the relative efficiencies of the “challenging arthritis” intervention programs in the study groups.
The sample size recruited for the study is around 20% less than the power calculation done by the authors at the start of the study. This could have resulted in a type II error where the study might not have been able to portray the difference between the groups.
This study definitely raises questions on the efficacies of such self management programmes but does not imply that they should not be instituted. A further research and economic analysis is needed to ensure that the government plans of implementing expert patient programmes are evidence based. It might also be of interest to look into the factors that have brought the discrepancies in the outcome of the various studies.
1. Solomon DH, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee TH .Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. J Rheumatol. 2002 Feb; 29(2):362-8.
Rapid Response:
Dilemmas surrounding implementation of expert patient programmes.
The findings of this study are contrary to the consistent evidence from other studies, but it is interesting to note that a similar study done in the primary care setting in United States also did not demonstrate significant clinical benefits(1).
Although this study was well designed, there are few issues that might have had a bearing on the outcome. Out of the 2891 patients approached, only 812 patients entered into the study. The patients who declined to participate in the study might have grounds that could have influenced the outcome. Although the patients were randomised by stratifying certain baseline characteristics, they have not been randomised for other important confounding factors like associated co-morbidities including obesity, alternative therapies, duration and stage of illness. This might have significantly skewed the result. This may also explain the observed lack of significant difference in the number of subsequent consultations with the general practitioners. It might also have been of interest to consider the relative efficiencies of the “challenging arthritis” intervention programs in the study groups.
The sample size recruited for the study is around 20% less than the power calculation done by the authors at the start of the study. This could have resulted in a type II error where the study might not have been able to portray the difference between the groups.
This study definitely raises questions on the efficacies of such self management programmes but does not imply that they should not be instituted. A further research and economic analysis is needed to ensure that the government plans of implementing expert patient programmes are evidence based. It might also be of interest to look into the factors that have brought the discrepancies in the outcome of the various studies.
1. Solomon DH, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee TH .Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. J Rheumatol. 2002 Feb; 29(2):362-8.
Competing interests:
None declared
Competing interests: No competing interests