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25.06.2019 | Original Research

“Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV

verfasst von: Jennifer K. Carroll, MD, MPH, Jonathan N. Tobin, PhD, Amneris Luque, MD, Subrina Farah, MS, Mechelle Sanders, PhD, Andrea Cassells, MPH, Steven M. Fine, MD, PhD, Wendi Cross, PhD, Michele Boyd, MPA, Tameir Holder, MPH, Marie Thomas, Cleo Clarize Overa, BA, Kevin Fiscella, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 9/2019

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Abstract

Background

Little is known about strategies to improve patient activation, particularly among persons living with HIV (PLWH).

Objective

To assess the impact of a group intervention and individual coaching on patient activation for PLWH.

Design

Pragmatic randomized controlled trial.

Sites

Eight practices in New York and two in New Jersey serving PLWH.

Participants

Three hundred sixty PLWH who received care at participating practices and had at least limited English proficiency and basic literacy.

Intervention

Six 90-min group training sessions covering use of an ePersonal Health Record loaded onto a handheld mobile device and a single 20–30 min individual pre-visit coaching session.

Main Measures

The primary outcome was change in Patient Activation Measure (PAM). Secondary outcomes were changes in eHealth literacy (eHEALS), Decision Self-efficacy (DSES), Perceived Involvement in Care Scale (PICS), health (SF-12), receipt of HIV-related care, and change in HIV viral load (VL).

Key Results

The intervention group showed significantly greater improvement than the control group in the primary outcome, the PAM (difference 2.82: 95% confidence interval [CI] 0.32–5.32). Effects were largest among participants with lowest quartile PAM at baseline (p < 0.05). The intervention doubled the odds of improving one level on the PAM (odds ratio 1.96; 95% CI 1.16–3.31). The intervention group also had significantly greater improvement in eHEALS (difference 2.67: 95% CI 1.38–3.9) and PICS (1.27: 95% CI 0.41–2.13) than the control group. Intervention effects were similar by race/ethnicity and low education with the exception of eHealth literacy where effects were stronger for minority participants. No statistically significant effects were observed for decision self-efficacy, health status, adherence, receipt of HIV relevant care, or HIV viral load.

Conclusions

The patient activation intervention modestly improved several domains related to patient empowerment; effects on patient activation were largest among those with the lowest levels of baseline patient activation.

Trial Registration

This study is registered at Clinical Trials.Gov (NCT02165735).

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Titel: “Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV
verfasst von: Jennifer K. Carroll, MD, MPH
Jonathan N. Tobin, PhD
Amneris Luque, MD
Subrina Farah, MS
Mechelle Sanders, PhD
Andrea Cassells, MPH
Steven M. Fine, MD, PhD
Wendi Cross, PhD
Michele Boyd, MPA
Tameir Holder, MPH
Marie Thomas
Cleo Clarize Overa, BA
Kevin Fiscella, MD, MPH
Publikationsdatum: 25.06.2019
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 9/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05102-7

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“Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV

Abstract

Background

Objective

Design

Sites

Participants

Intervention

Main Measures

Key Results

Conclusions

Trial Registration

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Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Background

Objective

Design

Sites

Participants

Intervention

Main Measures

Key Results

Conclusions

Trial Registration

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