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What was the Co-Creating Health Initiative?

The Co-Creating Health Initiative (CCHi) was a national programme, funded by The Health Foundation, which aimed to transform health care services so that people with long term conditions could take a more active role in their health. The programme was delivered between November 2007 and September 2010, and included three strands of action:

1. An advanced development programme for clinicians to develop the skills required to support and motivate their patients to take an active role in their own health

2. A self-management course for people with long-term conditions to develop the knowledge and skills they require in order to manage their long-term condition and work in effective partnership with their clinicians

3. An organisational development programme to support patients and healthcare professionals, working together, to identify and implement new approaches to health service delivery which enable patients to take a more active role in their own health.

A team from the Applied Research Centre in Health and Lifestyle Interventions at Coventry was awarded funding to evaluate the Co-Creating Health Initiative (CCHi) for improving the care for people with long-term conditions. The evaluation has used mixed-methods to determine both the effectiveness of the initiative for improving health outcomes and to understand the process of change and improvement that has resulted from the initiative. The team recently presented the results of the self-management programmes at the UK Society for Behavioural Medicine Conference in Oxford.

The content of the self-management programmes was modelled on the lay-led, generic Expert Patient Programme. They were co-delivered by health professional and peer tutors. The programmes contained behavioural change techniques such as goal-setting, action planning and problem solving, plus condition specific content. Programmes focussed on four long-term conditions: diabetes, musculoskeletal pain, depression and chronic obstructive pulmonary disease (COPD)

Condition-specific results

Diabetes: 77% patients completed the course. 60.2% showed a meaningful improvement in patient activation scores. There was also a significant improvement in diabetes-related quality of life but not health-related quality of life. There were no improvements in health status, depression or anxiety levels.

Musculoskeletal pain: 69% of patients completed the course, and 50.3% of those showed meaningful improvement in patient activation. Health status, anxiety and depression and self-management skills were also significantly improved.

Depression: 69% of patients completed the course and 56% of those showed a meaningful improvement in patient activation. Health –related quality of life, health status, anxiety and depression and self-management skills also significantly improved.

COPD: 79% of patients completed the course and 49.5% of those showed a meaningful improvement in patient activation and felt more mastery of their condition.

1170 patients completed measures before the programme and 588 completed measures six months afterwards. Across all four conditions, 54% of patients showed a meaningful (>4 point) improvement in patient activation, which means there are more likely to carry out self-care activities. Health-related quality of life, health status, anxiety and depression were also significantly improved six months after the programme.

Clinician results

Clinicians from CCHi participating sites were offered an opportunity to attend Clinicians’ Advanced Development Programme (ADP) - training for healthcare professionals working with patients with long term conditions that addresses the principles and practice of self-management support and teaches four specific techniques that have demonstrated an impact on the clinician-patient relationship and can be used during clinical consultations. The four key skills include:

· establishing an empathic clinician-patient relationship

· joint agenda setting for each consultation

· collaborative goal setting, exploring ambivalence about change

· using problem-solving skills and using systemic tools to support goals’ follow up

The ADP recruited 665 clinicians and 465 completed the programme. 489 clinicians completed the baseline measures before attending the programme and 407 completed post ADP measures. Attending ADP programme increased clinicians’ confidence to support self-management and increased using clinical self-management support practices (including building an equal clinician-patient relationship, using behaviour change processes and exploring the patient’s self-management strategies) and patient centred practices (including customising the treatment to a patient’s preferences and taking an individualised approach). In interviews clinicians confirmed that the training increases use of self-management support practices, however some found ADP techniques irrelevant and difficult to use.

Local Involvement in Co-Creating Health

Coventry and Warwickshire Partnership Trust, University Hospitals Coventry and Warwickshire NHS Trust, NHS Warwickshire PCT and NHS Coventry PCT were all involved in this study.

Coventry and Warwickshire were comparator sites in the main evaluation for depression and diabetes. This means that the improvement programme and self-management programmes were not run locally. Instead, patients were recruited and completed many of the same evaluation outcome measurements as in areas where the programme did take place. This allows for comparisons to be made between sites where the programme was run, and sites where it did not run. The particular analysis presented here does not include the data from the local population.

For further information, please see the full report: http://www.health.org.uk/publications/co-creating-health-evaluation-phase-1/