21 research outputs found
A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol
BackgroundPatients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care.MethodsThe evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial.DiscussionIf the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population.Trial registration numberISRCTN: ISRCTN9094004
Age Differences in the Underconfidence-With-Practice Effect
In two verbal learning experiments, the authors examined the accuracy of
memory monitoring and the underconfidence-with-practice (UWP) effect
in younger and older adults. Memory monitoring was operationalized as
judgements of learning (JOL). An open issue is whether UWP can also be
found in older adults. In the first experiment, both younger and older
adults overestimated their memory performance in the first trial, but
the older group differed from the young group in the second trial. The
JOLs given by older participants matched, on average, their recall
performance. In fact, the UWP effect was not observed in any of several
conditions in older participants. In the second experiment involving five
study-test cycles and two age groups, the same basic pattern of results
was present: Older adults did not show an UWP effect. These findings
appear to fit into a framework of dual factors affecting JOLs, which
posits that the magnitude of JOLs derives both from an anchoring point
and from on-line monitoring of items