The expert Patients Program, a lay-led chronic disease self-management course, was developed to improve self-care support and skills. The course was designed for anyone with a self-defined long-term condition, and attracts a heterogeneous group of patients. A randomized controlled trial has demonstrated effectiveness in improving subjective health. However, it is unknown whether particular patient characteristics predict the impact of the course. Reeves and coworkers sought: (a) to determine whether baseline characteristics predict clinical outcomes from attendance at a chronic disease self-management course; and (b) to assess whether identification of such characteristics would assist in targeting the course to individuals most likely to benefit. A post-hoc subgroup analysis of data from a randomized controlled trial explored predictors of three trial outcomes: self-efficacy, energy, and health-related quality of life. Participants with self-defined long-term conditions (n = 629) were recruited from community settings in all 28 strategic health authorities in England. Multiple regression techniques were used to examine interactions between baseline variables and trial outcomes. The predictors demonstrating significant interactions were: age and general health, and baseline values for self-efficacy, energy levels, and health-related quality of life.

WHAT THE STUDY MAY MEAN TO YOU: Reeves and coworkers found that participants with lower self-efficacy and health-related quality of life at baseline demonstrated more positive health outcomes. In addition, the Expert Patients Program may have a protective effect on health-related quality of life for patients with poor health and low confidence. Younger people benefited substantially more than older people. Results suggest that positive outcomes associated with the course can be demonstrated with a wide variety of patients, although it may be worthwhile to encourage attendance of younger patients, in those lacking confidence, and in those who poorly cope with their condition. We hope these investigators and others can build on this knowledge in designing future self-management programs.

D Reeves et al. Predicting who will benefit from an Expert Patients Programme self-management course. British Journal of General Practice, 2008;58:198-203.