Scores ≥11 are considered VE 821 to indicate probable clinical anxiety and depression (“cases”). Self-management ability was measured using the heiQ [25]. Patients are asked to rate items on a 4 point likert scale ranging

from “strongly disagree” (1) to “strongly agree” (4). Higher scores represent higher levels of self-management abilities. The eight scales are: positive and active engagement in life; health directed behavior; skill and acquisition technique; constructive attitudes and approaches; self-monitoring and insight; health services navigation; social integration and support; emotional well-being. Condition specific measures for COPD, depression, diabetes and pain were also collected at baseline and 6 months follow-up. Interviews were also conducted with patients and tutors across all 4 conditions. These data are reported separately in other publications [26]. All data analyses were conducted using IBM SPSS Statistics 20. The main analysis involved only those patients who attended ≥5 SMP sessions (defined as course completers) and returned 6 month follow-up questionnaires. The level of statistical significance Z-VAD-FMK nmr was set at p = 0.05. An intention to treat (ITT) analysis was also performed on all patients, irrespective of the number of sessions attended to ensure that the effectiveness of the program has not been overestimated. Missing 6 month follow-up data (T2) were replaced

with baseline (-)-p-Bromotetramisole Oxalate data, last observation carried forward.

Changes in the mean values of the patient outcomes were compared over time using paired t tests and General Linear Model for repeated measures. The outcome variables were normally distributed. For the main analysis only important prognostic factors such as age, gender, long-term condition, co-morbidity, number of sessions attended and socioeconomic factors (education, employment status) were adjusted for using analysis of covariance. Effect sizes (Cohen’s d) [27] were calculated using the following calculation: the mean score at 6 months minus the mean score at baseline divided by the standard deviation at baseline. Recommended boundaries [27] were used to determine small (0.2), moderate (0.5) and large effect sizes (0.8). The heiQ scale developers recommend a distribution-based cut-off of ES = 0.5 as a standardised cut-off [28]. Based on this cut-off, three categories of change were defined: ‘substantial improvement’ (ES ≥0.5), ‘minimal/no change’ (−0.50 < ES < 0.50), ‘substantial decline’ (ES ≤−0.5). We also looked the proportion of patients whose PAM scores improved by 4 points. Changes in “caseness” for anxiety and depression between baseline and 6 months follow-up were tested using McNemar’s test. In total, 1850 patients contacted the EPPCiC recruitment helpline, and of these, 563 (30%) patients did not register to attend the SMP.