Background: healthcare professionals need to increase awareness of patients’ capacities to assume a more active role in their own care and learn mechanisms that increase this capacity. Communities of practice (CoP), based on the idea that learning involves a group of people exchanging experiences and knowledge, are an innovative educational tool that can change attitudes of professionals towards patients’ empowerment.
Objectives: to assess the effectiveness of a virtual CoP (vCoP) at improving primary healthcare professionals’ attitudes to the empowerment of patients with chronic diseases.
Methods: two-arm, unblinded, cluster-randomized controlled pretest-post trial with practices as randomization unit and professionals as analysis unit. Participants: General Practitioners/nurses. Patients were eligible if aged 18 years and over, and diagnosed with at least one chronic disease. Randomization: we randomly selected 63 practices in Catalonia, Madrid and Canary Islands, Spain, and allocated 31 to the intervention group (IG) and 32 to the control group (CG). Intervention: IG was offered participation in a vCoP web 2.0 platform for 12 months; CG received usual training. Outcome measures: primary outcome was measured by Patient-Provider Orientation Scale (PPOS) questionnaire at baseline to 12 months; secondary outcomes included Patient Activation Measure (PAM) questionnaire. Analysis: we used a multilevel, linear regression, with random effects for practices, adjusting for professionals' and patients' characteristics, to estimate the effect of participating in the vCoP. This report follows CONSORT cluster-randomized trials extension.
Results: 183 professionals (recruiting 1155 patients) were assigned vCoP; 138 usual training (766 patients) (T1). We analyzed 134 professionals (808 patients) in IG and 119 professionals (613 patients) in CG. Outcome (completers’ analysis): PPOS total scores (range 1 to 6) were significantly higher in vCoP arm than usual training (mean adjusted difference = 0.15 points higher in vCoP arm, 95% confidence interval (CI) 0.04 to 0.23; P = 0.008); PPOS sharing score (mean adjusted difference = 0.28 points higher in vCoP arm, 95% CI 0.13 to 0.43; P < 0.001); PPOS caring score (mean adjusted difference = 0.01 points higher in vCoP arm, 95% CI −0.11 to 0.13; P = 0.854). PAM was similar between groups (mean adjusted difference = −0.15 points, 95% CI −3.31 to 3.01; P = 0.927).
Conclusions: the vCoP intervention led to better results than usual training in PPOS total score due to the sharing component. We observed no significant changes in PAM. Results (preliminary) may be interpreted with caution due to the number and difference of missing participants between the two groups and the low internal consistency of the outcome measure used.
Patient or healthcare consumer involvement: patients were involved as PAM questionnaire was secondary outcome.
Co-financed by Fondo Europeo de Desarrollo Regional/Fondo de Investigaciones Sanitarias.ISCIII. Ministerio de Economía, Industria y Competitividad