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Evaluating the Effects of Self-Managed and Monitored Healthcare on Health and Cost Outcomes (Abstract and Citation only)
Thesis

Evaluating the Effects of Self-Managed and Monitored Healthcare on Health and Cost Outcomes (Abstract and Citation only)

Phillip Davis
Southern Cross University
Doctor of Philosophy (PhD), Southern Cross University
2025
DOI:
https://doi.org/10.25918/thesis.596
Appears in  Recent Southern Cross PhD Theses

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Abstract

Patient-SBAR Communication Self-Management Chronic Disease
Background: Chronic diseases affect over one-third of the global population and account for 75% of Australia's health burden. To empower patients in the Self-Management of their chronic condition, Wagner’s Chronic Care Model emphasises the importance of clinician-patient collaboration, which is influenced by communication. Brief consultations and technologies like telehealth can challenge the necessary communication clarity and effectiveness required for patients to effectively self-manage their chronic condition and achieve their desired health goals. Aims and Objectives: This research examines how patient communication capabilities influence their ability to self-manage chronic conditions, and the impact this might have on engagement with healthcare providers, health status, health service utilisation, and overall care costs. The objectives were: (i) Developing two new communication modules: (1) a General Communication training module (Module-1) and (2) a specific Patient-SBAR (Situation, Background, Assessment, Recommendation) communication training module (Module-2); (ii) Validating a new survey tool integrating the existing PACIC+ (Patient Assessment of Care in Chronic Conditions) tool with six proposed new Self-Management measures and; (iii) Assessing the Patient-SBAR strategy's effectiveness to empower patients in managing their own care compared to the General Communication training module alone. Method: Patients with one or more chronic conditions were recruited from a 200 bed Queensland hospital via clinic advertisements and direct clinician referral. Stage 1 comprised clinical research with 100 participants to validate the PACIC+ and six new Self-Management survey measures for (a) validity in an Australian sample, (b) scale reliability, and (c) application in assessing health status, service utilisation, and associated indicative cost outcomes. Stage 2 was conducted as a clinical trial with 65 patients, randomly assigned to Care as Usual (CAU) or Patient SBAR (PSB). Both groups received General Communication Module-1 training; the PSB group additionally received Patient-SBAR Module-2 training, while the CAU group repeated Module 1 as the control condition. Participants from Stage 1 were excluded from Stage 2. Outcomes were measured using the validated PACIC+ and six new Self-Management measures survey which assessed across patient empowerment, self-efficacy measures, unplanned health presentations and cost-effective measures. Data was analysed using paired and independent t-tests. Due to the small sample size, Bootstrap analysis was used to help validate outcomes and provide an estimate for the true parameter value of the target population. Service demand costs were calculated using the average number of unplanned care episodes and hospital admissions before and during the study. Indicative service demand costs were calculated using this information and the National Hospital Cost Data Collection data. Results: In Stage-1, the PACIC+ and six new Self-Management measures tool demonstrated significant reliability and validity (Time-1 and Time-2: Total score r(48) = .43 and; New supplementary items: Confidence r(48) = .54; Understanding r(48) = .62; Support r(48) = .43; Overall Health r(48) = .42; Acute Episodes of Care in 1-month r(48) = .42; p < .01; Overall Health Change r(48) = -.31, p = .03, and validity (Cronbach’s alpha = .96). In Stage-2 the General Communication Module-1 training significantly improved Self-Management (PACIC+ Total Score (t (54) = 3.71, p < .001) pre-post improvements (Time-1: M = 70.7; SD = 21.7; Time-2: M = 77.7; SD = 23.4) and significantly reduced acute care episodes (t (13) = 2.96, p = .011). There were no significant group differences in change scores from Time-2 to Time-3. Comparing groups at baseline (Time-1) and at study conclusion (Time-3), however, showed significant improvement with a large effect size for the PSB group in: patient understanding (t (19) = 2.6, p = .018; Cohen’s d = .58), and support for Self-Management (t (19) = 2.6, p = .018; Cohen’s d = .58), with a significant reduction in service demand and cost for acute care episodes (t (19) = 2.8, p = .013; Cohen’s d = .79; Mean Cost Difference = $800.80; SD = $1312.07), and hospital admissions (t (19) = 2.1, p = .045; Cohen’s d = .48; Mean Cost Difference = $629.20; SD = $1310.95). Discussion: The PACIC+ tool and six new Self-Management measures is reliable for monitoring chronic illness Self-Management in patients with chronic diseases in Australia. Communication training significantly impacted health outcomes and service demand, with the PSB group showing greater overall improvement. Limitations included (i) A small sample size as a consequence of reduced recruitment due to COVID lockdowns, which was addressed by Bootstrap analysis; (ii) The sequencing of training for the PSB group (Module-1 followed by Module-2). Conclusions: Structured general communication training, especially incorporating the specific Patient-SBAR model, improves patient empowerment and health outcomes, whilst reducing healthcare costs. Findings support integrating structured communication training into chronic care management and the potential of communication as a therapeutic tool. Further research with a larger sample is warranted to assess the independent impact of the Patient-SBAR model compared to general communication training.

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