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Introduction: The most burdened persons who are frequent hospital users are characterized by chronic diseases, multimorbidity, low socio-economic status, and higher age. These persons have complex care needs and their burden of disease and healthcare tasks may exceed their resources and self-management skills. When unmet, complex care needs may lead to unplanned hospital admissions. Hospital admissions are associated with bed availability and quality of primary care and therefore indicate lapses in preventive and proactive healthcare. Self-management support is developed to educate and support patients' in managing chronic disease, but the evidence base of telephone-based interventions is poor with mixed results. Aims and methods: This study evaluates Proactive Health Support (PaHS) in a national randomized controlled trial. Participants were at risk of emergency hospital admissions with 1. chronic diseases, 2. = three unplanned hospital contacts, or 3. age = 65 years with a preventable hospital admission. The intervention was an addition to usual care and began with a physical startup session followed by telephone sessions to support self-management focusing on knowledge, coping, self-care, and healthcare across sectors. The two co-primary outcomes were HRQoL (Mental Health Component Summary Score of SF36v2) analyzed with mixed models and hospital admissions analyzed with poisson regression at 6 months. Results: During the study period, 6402 persons were randomized. HRQoL was significantly improved at 6 months (Est. 1.4992, p= <.0001) and at three and 12 months on all 10 scales. There was no effect of the PaHS intervention on hospital admissions at six months with an adjusted estimate of 0.0074 (p= 0.8691). Instead, the intervention seemed to increase the use of primary healthcare services including psychologists and anxiety medication. Conclusions: The PaHS intervention improved HRQoL, did not prevent hospital admissions but seemed to increase the use of primary healthcare services. Implications: Participants were included as subjects, exploring their experiences as well as patient-reported outcomes. With few dropouts the intervention was acceptable for participants. To promote transferability the method of inclusion needs further development due to legal restrictions in using predictive models. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, patient-accessible health records are gaining popularity, contributing to, among others, patients' autonomy. Since autonomy is an important aim in the Dutch transformation of care for youth, three organizations developed a client-accessible record as an instrument to enhance their client's autonomy. We investigated how a client-accessible record was received by its users and whether it contributes to autonomy among youths and their parents. Methods: A mixed methods design was used to measure autonomy and the process indicators acceptability, adoption, appropriateness and fidelity. Autonomy was assessed with selfconstructed surveys among professionals and clients, measured at baseline and in follow-up. Change in autonomy was tested using independent-sample T-tests. To evaluate the process, project meetings were recorded and analyzed qualitatively. Focusgroup interviews with clients and professionals deepened understanding of autonomy and process indicators. Results: Preliminary analyses of the survey among 914 parents and 89 youths show an improvement in experienced autonomy among both groups. This improvement was stronger when respondents had actually accessed their client record. In focusgroups, parents reported that transparency of the client record was the most important benefit and enhanced their trust in professionals. Professionals said that parents acted more autonomous. They took a more active role in planning appointments, gave more feedback on visit notes and corrected mistakes. Youths especially appreciated having control over who accessed their client record. The process evaluation showed high acceptability scores among clients, independent of demographic features. However, adoption appeared to be lower among lower educated Respondents. Conclusion: A client-accessible youth health record bears potential to enhance a client's autonomy. More research is needed to explain the contradiction between acceptability and adoption outcomes. [ABSTRACT FROM AUTHOR]