sf36 analyses of safh courses jan 09 - mar 09

8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09

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An extract from the PCT Health Equity Report (2007- 2009)

On SF36 analyses of Healthy Moves and Self-management courses

Some findings from the BMed Sci student Project May 2009 titled

“AN EVALUATION OF THE IMPACT OF SELF MANAGEMENT COURSES WITHIN TOWER HAMLETS; A)

PATIENT/PARTICIPANT ASSESSMENT OF COURSES AND B) PRIMARY CARE CLINICIAN’S KNOWLEDGE OFCOURSES”

Funded by the Health FoundationBased in the Clinical Effectiveness Group,Working in partnership with Social action for Health and Tower Hamlets PCT



• Assessing primary care staff understanding of self management groups

In January 2009 a survey of all GP practices was undertaken to explore understandingand current referral levels to both generic SMGs such as the expert patient programmeand to disease specific courses such as HAMLET and pulmonary rehabilitation.There was 100/265 (37.7%) response rate, with a response from 31/38 practices.88% of responders knew about the EPP, and 76 % were aware of the EPP coursesbased within Tower Hamlets. However 52% were not aware of the referral process tothe generic self management courses.

Referrals to expert patient programmes

This illustrates the low level of referrals to the expert patient programme initiated by

primary care teams

Feedback and views on self management courses

In general respondents gained more feedback about attendance at disease specificcourses, and the perception of these courses was more positive than for the generic

EPP.Response Generic Expert Patient

Programmes %

Disease Specific Expert

Patient Programmes %

Received

course

feedback

Yes 35 56

No 63 38

Nature of

feedback

Positive 12 35

Negative 6 4



Mixed 19 18

Social marketing and the referral process to SMGs

The following comments are taken from the free text section of the questionnaire,looking at the theme of ‘course referral and proceedures’. They illustrate the currentdifficulties primary care teams have in understanding the role of the generic courses inthe chronic disease management pathway.

2 Course procedure

2.1 Advertising 2.2 Referral 2.3 Follow up 2.4 Education

V12: Programs are

not well marketed

M1: Difficult to know

who attends as there are

no referral forms?

R8: Refresher

courses are

required

HH12: I would like to

attend a session to see for

myself how to motivate

patients

R4: I find it difficult

to refer patients to

EPP due to the lack

of details of where

and when they are.

V3: Should be one point

of referral for exercise

courses

M1: Monitoring

system needed

B3: Patients should be

receiving education every

time they visit the

surgery

N3: Need course

timetables available

N3: Need a referral

process

V12: Courses

are never

followed up

00: More group

education sessions are

needed for staff

II1: Must be widely

marketed directly at

patients

V6: I feel that referring

patients to EPP in some

ways feels like rejection

to the patient. I would

prefer if the patient was

directly contacted by theorganisation.

F5: Need

refresher

courses

poor training

opportunities

V4: We need visual

promotional material

and take home

photocopies and

leaflets

V4: We need to encourage

self referrals

V4: Patient has left

leaflets about courses

in the practice

J2: Promote self referrals

J2: More promotionalmaterial around the

community to help

advertise courses to

patients

Y1: enable a standardisedreferral process where

attendance can be

monitored

O1: More advertising

material is required

for patients and

doctors



00: no code

Improved take up of these generic EPP courses will depend on a strong PCT wide focuson publicity, self referral mechanisms and a single point of entry for health professionalreferral.

These comments apply less to the disease specific SMGs, which fall more within thetraditional medical model and show more evidence of becoming attached to the diseasepathway.

(Further details of the survey method and full results available on request from theproject team)

Analysis of the ‘Healthy Moves’ SMG run by Social Action for Health

The Healthy moves course was developed by SAfH as a hybrid self management/exercise course containing self efficacy elements of the EPP programme,but including more directive sessions on diet and activity, with sessions on commonchronic diseases such as diabetes and heart disease. There is an emphasis on doingphysical activity during the sessions.

The analysis is based on 20 courses, which ran during January to March 2009.

• 66% of the participants attending the courses were female

• 93% of course participants were Bangladeshi

• Over 85% of course attendees had diabetes

• 75% of participants were directly invited to attend the course by SAfH, 13% were

recruited by their doctors.



Data for analysis was collected from 284 participants as follows:

• 166 completed sets of data (completed pre and post SF36 forms)

• Missing data: 118 participants without complete data sets (info from pre and postSF36 form) 35/284 missing pre course SF36 data and 83/284 missing post SF36

data.

The initial analysis was designed to explore whether there was a significant change inSF-36 summary scores pre and post courseThe Null Hypothesis being: There is no change in SF-36 Summary scores pre and postcourse

Box plot of pre and post course SF-36 scores in the physical and mental healthdomain.



0

2 0

4 0

6 0

8 0

1 0 0

S F - 3 6

S c o r e

Physical & Mental Health Domain Summary Scores

pcs pcsPost

mcs mcsPost

PCS = Pre Physical component score PCSPost = Post Physical component

score

MCS = Pre Mental component score MCSPost = Post Mental component

score

The null hypothesis for the physical health domain can be rejected. The paired ttestshows there is statistically significant difference between the pre and post physicalsummary score.p=0.00 (CI -20.01 -11.73)

The null hypothesis for the mental health domain can be rejected. The paired ttestshows there is statistically significant difference between the pre and post mentalsummary score.p=0.00 (CI -22.07 - 13.05)

Comparison of the generic EPP courses with the healthy moves courses based on

the SF-36 physical and mental health summary scores.

This analysis is based on 5 of each course type, with 118 attendees.

Overall, all domains making up the physical and mental health component of the SF-36demonstrated an improvement at post course intervention.However, Healthy Moves exercise courses showed greatest improvements at increasingoverall SF 36 score.



Using multiple regression analysis to adjust for age group, baseline score, existing

health problems and gender, there was a significant difference in the physical healthsummary score between the two course types.Averege difference in score -11.3 (95% CI -19.7, -2.8) p = 0.010

The non-parametric Mann-Whitney test was used to assess whether there is a differencein mental health summary scores between the two course types (as the assumptions for linear regression were not met by the data). The Healthy Moves Course shows greatestchange in score.The Mann-Whitney test shows there is a significant relationship between overall changein pre/post mental health scores and course type Prob > |z| = 0.0356. This does notadjust for other factors.

sf36 analyses of safh courses jan 09 - mar 09

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