109. Effects of Group HIV Health Education on Patient Centered Outcomes: A Randomized Controlled Trial
JE Bormann, VA San Diego Health Care System, UCSD; AL Gifford, VA San Diego Health Care System, UCSD; M Shively, VA San Diego Health Care System, SDSU; M Lee, VA Greater Los Angeles HSR&D Center for Excellence; S Bozzette, VA San Diego Health Care System,UCSD, RAND
Objectives: Self-management educational programs have improved quality of life and health status in a variety of chronic disease patients. We evaluated the effectiveness of three different HIV patient education and support programs: Self-Management Education (SME), a nurse- and peer-led group intervention emphasizing disease self-management skills; Social Support (SS), a nurse- and peer-led intervention offering social contact in groups, and Printed Materials (PM), a collection of written informational materials provided for subject use, on patient-centered outcomes in HIV patients.
Methods: A sample of 209 symptomatic HIV infected adults (Veterans and non-Veterans) were recruited and individually randomized to one of three groups: SME (n = 83) providing 6 weekly 2-hour sessions of education and skill training; SS (n = 64) providing 6 weekly 2-hour social support sessions, and PM (n = 63) with no group meetings. Participants completed the following patient centered measures: Symptom Bothersomeness, Beck Depression Inventory, Global Fatigue Index, Perceived Stress Scale, Illness Intrusiveness, Health Distress and SF-36. Data were collected at baseline, post-intervention, and 6 months. Repeated measures ANCOVAs were performed on all outcome variables, with adjustment for clustering. Covariates included in the analyses were age, gender, and CD4 count. For selected variables, ANCOVAs on change scores were performed.
Results: Analyses revealed no significant pre- to post-intervention differences
between groups over time with respect to patient centered outcomes. There were also no differences in outcomes at 6-month's follow-up. Change score ANCOVAs were performed on Symptom Bothersomeness and Illness Intrusiveness scores to account for baseline differences in these variables. No differences were found in Symptom Bothersomeness by group over time. Illness Intrusiveness scores were lower in the SME group at post-intervention and neared significance (p < .06).
Conclusions: Results fail to support significant differences between these educational and support modalities on patient centered outcomes. Previous studies of chronic disease self-management groups were conducted before the availability of highly active anti-retroviral therapy (HAART) and were generally compared with "usual care" rather than social support or printed material control groups. Three factors, self-selected patient population, changes in HIV regimens to include HAART, and the effect of medication adherence on symptoms, may have contributed to the lack of influence of the group health education programs.
Impact: This study did not identify significant benefits of self-management education on health outcomes in HIV infected adults compared to less intensive educational and support modalities. How best to conduct patient education in the HAART era is yet to be determined.