In an exploratory analysis, 42% (75/150) of patients in the intervention group were classified as successful self managers at study exit, from review of appropriateness of use of self management therapy.
COPD readmissions/deaths were reduced in successful self managers compared with unsuccessful self managers (20/75 (27%) v 51/105 (49%); hazard ratio 0.44, 0.25 to 0.76; P=0.003).
These rates are similar to those for the unsuccessful self managers.
Macdonald et al [ 33] note how practice nurses in primary care in adapting to this changing work context develop heuristic notions of patients as "good self managers and bad self managers", allowing this to dictate and anticipate illness trajectories.
Within the intervention arm of the study, we compared successful and unsuccessful self managers in terms of the study outcomes, using the methods detailed above.
Further study of the characteristics of successful self managers should allow predictive tools for this and for the objective measurement of efficacy to be created.
Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care.
46 47 The benefits of collaborative care extended beyond reductions in depressive and anxiety symptoms, with patients rating themselves as better self managers.
Exploratory analyses showed that successful self managers had a significant reduction in the primary end point, and multivariate analysis showed that successful self managers were more likely to be younger and living with others; other possible confounders including smoking status were not significantly different (table 3, web appendix D).
Successful self managers had significantly lower/worse self efficacy scores at baseline, although this difference did not survive multivariate analysis, suggesting that it was related to the other variables.
We found a significant reduction in readmissions among successful self managers, compared with those in the intervention group who did not master the technique (27% v 49%; hazard ratio 0.44, 0.25 to 0.76; P=0.003) (table 5; fig 4).
