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8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
http://slidepdf.com/reader/full/sf36-analyses-of-safh-courses-jan-09-mar-09 1/9
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
8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
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• 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
8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
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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
8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
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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.
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8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
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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.
8/14/2019 SF36 Analyses of SAFH Courses Jan 09 - Mar 09
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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.
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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.