The purpose of the study is to determine whether the quality of life of patients with multiple chronic conditions cared for by primary care physicians will improve due to the introduction of a chronic illness management intervention.

Condition	Intervention	Phase
Chronic Illness Quality of Life	Behavior: Multifaceted outreach facilitation for chronic illness care	Phase I

Further Study Details: 

Primary Outcomes: Difference between intervention and control groups of the average of the total SF-36 Health Survey physical and mental scores
Secondary Outcomes: Difference between intervention and control groups of the average of the ''''Healthy Days'''' Health Related Quality of Life-4 (HRQOL-4) scores
Expected Total Enrollment:  200

There is international recognition for the need of introducing improvement in chronic illness care. However, primary care physicians face a host of challenges for providing the best possible care to their patients. One of these problems is the lack of proper administrative systems. There is evidence indicating that tailored out reach facilitation is an effective means to improve practice performance. Traditionally, the approach to care for chronically ill patients revolved mostly around the treatment of a specific chronic condition in an ad hoc basis. It is more common in family medicine for the patient to have several chronic conditions. There is also evidence showing that better health outcomes are obtained when the patients’ life circumstances, desires and expectations are taken into consideration. Various models of chronic illness care have emerged that are patient center while attempting to be comprehensive. Our approach, following the Australian model, seeks to introduce systems/administrative innovations at the practice level, intended also to increase the involvement of patients with multiple chronic conditions on its own care, throw tailored out reach facilitation and care planning tools for physicians, in order to improve chronic illness management in primary care settings.

Ages Eligible for Study:  50 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Patient should suffer from any two or more chronic illnesses
• Patient should have been seen in the GP''''s office at least six to seven times in the previous year
• Patient should be 50 years of age or older

Exclusion Criteria:

• Suffering from dementia or a major psychiatric condition, being terminally ill, not being competent to give informed consent for participating in the study, or the doctors considers that the patient will not benefit from the intervention.

Please refer to this study by ClinicalTrials.gov identifier  NCT00153829

Jackie Schultz      613-562-5800  Ext. 2114    jschultz@uottawa.ca

Canada, Ontario
      University of Ottawa, Institute of Population Health, Ottawa,  Ontario,  K1N 6N5,  Canada; Recruiting

Study chairs or principal investigators

William Hogg, MD, CCFP,  Principal Investigator,  University of Ottawa   
Jacques Lemelin, MD, CCFP,  Principal Investigator,  University of Ottawa   

Study ID Numbers:  T-0528-029-22-CICM
Last Updated:  September 9, 2005
Record first received:  September 8, 2005
ClinicalTrials.gov Identifier:  NCT00153829
Health Authority: Canada: Health Canada
ClinicalTrials.gov processed this record on 2005-09-13