Spirituality, self-care, and social activity in the primary medical care of elderly patients—results of a cluster-randomized interventional trial (HoPES3)

BACKGROUND: Self-efficacy is decisive for the quality of life of elderly, multimorbid persons. It may be possible to strengthenpatients' self-efficacy can be strengthened by the targeted reinforcement of individual spirituality, social activity, and self-care.This hypothesis was tested with the aid of a complex intervention. METHODS: A non-blinded, exploratory, cluster-randomized, controlled trial was carried out, with primary care practices as therandomization unit (registration number DRKS00015696). The patients included were at least 70 years of age, had at least threechronic diseases, were taking at least three medications, and were participating in a disease management program. In theintervention group, primary care physicians took a spiritual history, and medical assistants advised the patients on the use ofhome remedies (e.g., tea, application of heat/cold) and on regionally available programs for the elderly. The primary endpoint-health-related self-efficacy, measured using the SES6G scale-and further, secondary endpoints were evaluated withmultistep regression analyses. RESULTS: Data from 297 patients treated in 24 primary care practices were evaluated. The analysis of the primary endpointindicated no effect (mean difference between study arms 0.30 points, 95% confidence interval -0.21; 0.81, d = 0.14, p = 0.25).Subgroup analysis revealed the following situation for the secondary endpoint "mental well-being" (SF-12 subscale): patientswho had already been using home remedies before the trial began experienced a marked improvement (a difference of 7.3points on a scale from 0 to 100; d = 0.77, p < 0.001). This was also the case for patients who stated that spirituality played amajor role in their lives (a difference of 6.2 points on a scale from 0 to 100; d = 0.65; p = 0.002). CONCLUSION: The main hypothesis concerning health-related self-efficacy was not confirmed. The results of the analysis ofsecondary parameters indicate that some subgroups of patients can benefit from the interventional approach.