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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

Peter Bower1, Anne Kennedy1*, David Reeves1, Anne Rogers1, Tom Blakeman1, Carolyn Chew-Graham1, Robert Bowen1, Martin Eden1, Caroline Gardner1, Mark Hann1, Victoria Lee1, Rebecca Morris1, Joanne Protheroe2, Gerry Richardson3, Caroline Sanders1, Angela Swallow1 and David Thompson4

Author Affiliations

1 Primary Care Research Group, Community Based Medicine, University of Manchester, 5th Floor Williamson Building, Oxford Road, Manchester M13 9PL, UK

2 Institute of Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, UK

3 Centre for Health Economics, University of York, York YO10 5DD, UK

4 Section GI Science, School of Translational Medicine- Hope, Clinical Sciences Building, Hope Hospital, Salford M6 8HD, UK

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Implementation Science 2012, 7:7  doi:10.1186/1748-5908-7-7

Published: 26 January 2012



Patients 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.


The 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.


If 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 number