Proactive Health Support

Frederiksberg University Hospital

Status: Completed

Conditions: Patients at Risk of Hospital Admission

Treatments: Behavioral: Proactive Health Support

Study type: Interventional

Funder types: Other

Identifiers

NCT03628469

SJ-677

Details and patient eligibility

About

Proactive Health Support is a randomized controlled trial of telephone-based self-management support. The primary aim of the intervention is to reduce hospital admissions and improve quality of life in patients with a high risk of hospital admission.

Full description

Participants are identified through an algorithm, that assigns each patient with a risk score of 0-100%. Patients with the highest risk in each of the five regions of Denmark are invited to participate.

Enrollment: 5,454 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Persons with a hospital contact within the last year caused by ≥ 1 of the following diagnoses: heart diseases (DI110, DI130, DI132, DI50), connective tissue diseases (DD86, DM05, DM06, DM08, DM09, DM30, DM31, DM32, DM33, DM34, DM35, DM36), pulmonary diseases (DJ40, DJ41, DJ42, DJ43, DJ44, DJ45, DJ46, DJ47, DJ60, DJ61, , DJ62, DJ63, DJ64, DJ65, DJ66, DJ67, DJ684, DJ701, DJ703, DJ841, DJ842, DJ843, DJ848, DJ849, DJ920, DJ961, DJ982, DJ983) or diabetes (DE10, DE11, DE14) Or
• Persons ≥ 18 years and ≥ three unplanned hospital admissions in the last six months Or
• Persons ≥ 65 years with a preventable hospital admission (predefined diagnoses: dehydration, constipation, lower respiratory tract infections, urinary tract infections, gastroenteritis, fractures, nutrition deficiency anemia, social causes and pressure ulcers) or a readmission (within 30 days)

Exclusion criteria

• Selected psychiatric diagnoses: substance abuse disorder (DF1), schizophrenia (DF2) or dementia (DF00, DF01, DF02, DF03, DF051)
• Metastatic cancer (DC77, DC78, DC79, DC80)
• Assisted living Facility
• Documented terminal illness or life expectancy < one year
• Assessment of dementia
• Major surgery planned within 6 months
• Hearing impairment
• Not speaking Danish
• Cognitive impairment
• Substance abuse, that impairs adherence
• No telephone
• Receiving similar trial intervention
• Other (including intervention not suitable)

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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5,454 participants in 2 patient groups

Proactive Health Support

Experimental group

Description:

The purpose of the intervention is to enhance patients' self-management strategies and thereby enable patients to cope with illness at home and prevent the development of those conditions, that are sensitive to preventive efforts.The intervention includes active listening, coaching and counselling and elements from case management such as assessing the need for healthcare services. Emphasis is on supporting and empowering the patient to make the necessary contacts to healthcare professionals.

Treatment:

Behavioral: Proactive Health Support

Usual care

No Intervention group

Description:

Usual care