Background Osteoarthritis (OA) is increasing in frequency and becoming a growing burden in terms of both illness and cost. Support for self-management may have a part to play in the effective disease management. However, the evidence for arthritis self-management support program is inconclusive, and economic evaluations in this field are relatively rare.
Objectives The purpose of this study was to identify changes in over time and costs of a newly developed self-management support program for Korean medical aid beneficiaries with osteoarthritis
Methods The research design was an open-label, randomized and controlled evaluation of a community-based self-management intervention. Medical aid beneficiaries with osteoarthritis were allocated to the intervention group (n=30) or the control group (n=30). The 8 week-intervention program which focused on patient-centered, tailored intervention was developed to support disease self-management. A trained case manager with cognitive-emotional-behavioral approaches and coaching strategy led the participants. Outcome measures included patient activation, joint flexibility, and health related quality of life. Data were collected at baseline, 8 weeks (post-intervention), 6 and 12-month follow-up using structured questionnaire, goniometer and tape. Data were analyzed using mixed-effects regression model. For economic evaluation, a cost-benefit analysis was done using the net benefit and benefit/cost ratio.
Results As compared with the control group, the experimental group showed significantly greater improvement across the follow-ups on patient activation (Time x Group, F=13.395, p<.0001), joint flexibility, (Time x Group, Right Shoulder F=7.550, p<.0001; Left Shoulder F=5.692, p=.001; Right Knee F=5.998, p=.0007; Left Knee F=3.395, p=.0195) and health-related quality of life (Time x Group, F=6.381, p=.0004). The experimental group had large initial improvements in patient activation, joint flexibility, and health–related quality of life. These improvements declined over time, but still were better than at baseline except for joint flexibility. The result of cost-benefit analysis was found that the total cost was 72,096 Korean won per person and the net benefit was 167,904 Korean won per person, so the ratio of benefit versus cost was 2.33.
Conclusions Findings indicate that this 8-week community-based self-management support program is effective for patient activation, joint flexibility and health-related quality and an efficient model of nursing care reducing healthcare costs for medical aid beneficiaries with osteoarthritis. This study has the potential to be a sustainable model for practice in the community.
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Disclosure of Interest Y.-H. Ahn Grant/research support from: This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012–8-5261).