Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial

This is a great article although the results are disappointing because there is no difference between intervention (WISE, whole system informing self management engagement) group and control group after making so much effort to help these patients. Statistically non-significant results it doesn’t mean clinically they’re non-significant; this indicates there might be a possibility that the self management intervention might work in reality but not showing significantly in statistical analysis. Therefore, there are a few points that we would like to discuss.

1.Sample inclusion criteria include diabetic, chronic obstructive pulmonary disease or irritable bowel syndrome. Although all of these three diseases are categorized as chronic diseases, the presenting symptoms, progress, causes, and treatment of each disease are very different. Thus, using the same self-management engagement plan to such different disease patient populations and using the same questionnaires to assess the effectiveness of the intervention is highly suspicious to say the least.

2.Validity and reliability of the WISE is not well explained. Qualification and criteria of trainer, facilitator, and clinical staff are unknown. Different staffs were employed to carry out WISE in different settings with varying environments. Community resources presented difficulties for assessing related factors of effectiveness prior intervention and to develop a standardized intervention.

3.There are three primary outcomes, all at 12 months: shared decision making, self efficacy, and generic health related quality of life. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity, and enablement. Since the diseases of the samples are categorized into three kinds with different presetting symptoms, outcome measures should consider including individual biological data and individual symptoms relive in order to exam effectiveness. In addition, patient satisfaction should be assessed to demonstrate how patient feels about the program and whether he understands the contribution to the patients.

4.By using a qualitative approach, interview randomly selected samples in this study to explore the rationales regarding failure to prove the benefits to patients from a patients’ point of view is another aspect.

5.The author stated “a common problem in health care services research is that effective interventions are often not feasible and feasible interventions are often not effective”. How to make effective interventions become feasible is a challenge. If an effective intervention is confirmed, maybe the lobby policy maker might be a way to make it become feasible.