Background
Self-management and demand management
Methods
Population
Intervention
Comparisons
Outcomes
Study design
Identification of studies
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Randomised controlled trial
-
Diagnosis of a long-term condition
-
Self-management or case management intervention
-
Adults (aged ≥ 18 years)
-
Report quantitative data on health care utilization (hospitalization rates/costs and total costs) and health outcomes (quality of life, depression and anxiety). Studies reporting non-amenable data for meta-analysis on both, health outcomes and health care utilization, were excluded from the review.
Data extraction
Analyses
Results
Study characteristics
Category | Characteristics | N (n = 184) |
---|---|---|
Context | Country | |
UK | 43 (23%) | |
US | 65 (35%) | |
European | 44 (24%) | |
Other | 32 (17%) | |
Patients | Condition | |
Arthritis | 14 (8%) | |
Cardiovascular | 53 (29%) | |
Diabetes | 11 (6%) | |
Mental health | 29 (16%) | |
Mixed disease | 13 (7%) | |
Respiratory | 44 (24%) | |
Pain | 20 (11%) | |
Mean Age (SD) | 58 (13) | |
% Male | 49% | |
Intervention | Content | |
Pure SM | 9 (5%) | |
Supported SM | 36 (20%) | |
Intensive SM | 87 (47%) | |
Case management | 52 (28%) | |
Sample size (SD) | 275 (272) | |
Range | 23-1801 | |
External validity | Excluded patients with other long-term conditions | 65 (35%) |
Proportion of eligible patients who did not take part in the study | ||
Not clear | 48 (26%) | |
<20% | 40 (22%) | |
21-40% | 55 (30%) | |
41-60% | 25 (14%) | |
61-80% | 14 (8%) | |
81-100% | 2 (1%) |
Relationships between cost and health outcomes
Effects of self-management support on health outcomes and utilisation
Combined QoL | Self-management QoL | Case management QoL | Combined hospital use | Self-management hospital use | Case management hospital use | |
---|---|---|---|---|---|---|
Respiratory
|
0.27 (0.16 to 0.37, n = 34, moderate)
|
0.28 (0.16 to 0.41, n = 27, moderate)
| 0.19 (0.02 to 0.36, n = 7, low) |
−0.21 (−0.32 to −0.09, n = 31, moderate)
| −0.19 (−0.33 to −0.05, n = 25, moderate) |
−0.26 (−0.42 to −0.10, n = 6, zero)
|
Cardiac
|
0.21 (0.14 to 0.28, n = 40, moderate)
| 0.19 (0.10 to 0.27, n = 27, moderate) |
0.26 (0.12 to 0.39, n = 13, moderate)
|
−0.23 (−0.34 to −0.13, n = 38, high)
|
−0.20 (−0.33 to −0.07, n = 25, high)
|
−0.29 (−0.47 to −0.11, n = 13, high)
|
Arthritis
| 0.16 (0.07 to 0.26, n = 11, zero) | 0.17 (0.07 to 0.27, n = 7, zero) | 0.13 (−0.13 to 0.39, n = 4, zero) | −0.06 (−0.22 to 0.10, n = 6, moderate) | −0.02 (−0.19 to 0.16, n = 5, moderate) |
−0.24 (−0.48 to 0.00, n = 1, NA)
|
Pain
| 0.13 (0.04 to 0.21, n = 19, low) | 0.12 (0.02 to 0.22, n = 15, low) | 0.20 (−0.10 to 0.50, n = 4, zero) | −0.03 (−0.34 to 0.28, n = 3, low) | −0.03 (−0.34 to 0.28, n = 3, low) | |
Diabetes
|
0.44 (0.14 to 0.75, n = 10, high)
|
0.44 (0.14 to 0.75, n = 10, high)
| −0.12 −0.29 to 0.05, n = 5, moderate) | −0.12 −0.29 to 0.05 n = 5, moderate) | ||
Mental health
|
0.22 (0.11 to 0.33, n = 26, high)
| 0.05 (−0.07 to 0.17, n = 15, moderate) |
0.38 (0.24 to 0.51, n = 11, high)
| −0.03 (−0.10 to 0.04, n = 21, low) | −0.03 (−0.16 to 0.10, n = 13, moderate) | −0.04 (−0.13 to 0.05, n = 8, zero) |
Mixed
| 0.13 (0.02 to 0.24, n = 10, moderate) | 0.11 (−0.03 to 0.24, n = 7, moderate) | 0.22 (−0.03 to 0.48, n = 3, moderate) | −0.12 (−0.20 to −0.03, n = 11, moderate) | −0.09 (−0.17 to −0.02, n = 8, zero) | −0.13 (−0.40 to 0.14, n = 3, moderate) |
Combined QoL | Self-management QoL | Case management QoL | Combined costs | Self-management costs | Case management costs | |
---|---|---|---|---|---|---|
Respiratory
|
0.27 (0.16 to 0.37, n = 34, moderate)
|
0.28 (0.16 to 0.41, n = 27, moderate)
| 0.19 (0.02 to 0.36, n = 7, low) | 0.09 (−0.14 to 0.33, n = 9, high) | 0.09 (−0.19, 0.37) N = 6, high) | 0.09 (−0.46 to 0.64, n = 3, high) |
Cardiac
|
0.21 (0.14 to 0.28, n = 40, moderate)
| 0.19 (0.11 to 0.27, n = 27, moderate) |
0.26 (0.12 to 0.39, n = 13, moderate)
|
−0.25 (−0.47 to −0.04, n = 9, moderate)
| −0.25 (−0.82, 0.32, n = 4, high) |
−0.27 (−0.44, −0.10, n = 5, moderate)
|
Arthritis
| 0.16 (0.07 to 0.26, n = 11, zero) | 0.17 (0.07 to 0.27, n = 7, zero) | 0.13 (−0.13 to 0.39, n = 4, zero) | 0.07 (−0.07 to 0.20, n = 11, moderate) | 0.14 (0.01 to 0.27, n = 8, moderate) |
−0.28 (−0.53 to −0.03, n = 3, zero)
|
Pain
| 0.13 (0.04 to 0.21, n = 19, zero) | 0.12 (0.02 to 0.22, n = 15, low) | 0.20 (−0.11 to 0.51, n = 4, zero) | 0.07 (−0.13 to 0.28, n = 13, high) | 0.15 (−0.06 to 0.36, n = 11, high) |
−0.41 (−0.74 to −0.08), n = 2, zero)
|
Diabetes
|
0.44 (0.14 to 0.75, n = 10, high)
|
0.44 (0.14 to 0.75, n = 10, high)
| 0.19 (−0.18, 0.55, n = 4, moderate) | 0.19 (−0.18, 0.55, n = 4, moderate) | ||
Mental health
|
0.22 (0.11 to 0.33, n = 26, high)
| 0.05 (−0.07 to 0.17, n = 15, moderate) |
0.38 (0.24 to 0.51, n = 11, high)
| 0.03 (−0.05 to 0.11, n = 14, low) | −0.04 (−0.23 to 0.15, n = 4, moderate) | 0.05 (−0.04 to 0.13, n = 10, low) |
Mixed
| 0.13 (0.02 to 0.24, n = 10, moderate) | 0.11 (−0.03 to 0.24, n = 7, moderate) | 0.22 (−0.03 to 0.48, n = 3, low) | 0.06 (−0.02 to 0.13, n = 7, zero) | 0.05 (−0.04 to 0.13, n = 6, zero) | 0.11 (−0.09 to 0.31, n = 1, N/A) |
Study quality and small study bias
Overall effect size | Effect size (high risk of bias) | Effect size (low risk of bias) | |
---|---|---|---|
95% CI | 95% CI | 95% CI | |
I2
| I2
| I2
| |
Health outcomes
| 0.22 (0.17 to 0.26) | 0.23 (0.18 to 0.29) | 0.18 (0.12 to 0.25) |
Hospital use
| −0.16 (−0.20 to −0.11) | −0.18 (−0.24 to −0.11) | −0.10 (−0.16 to −0.04) |
Costs
| 0.02 (−0.05 to 0.08) | 0.07 (−0.05 to 0.18) | −0.01 (−0.09 to -0.07) |
Overall effect size | Effect size (UK studies) | Effect size (Non UK studies) | |
---|---|---|---|
Health outcomes
| 0.22 (0.17 to 0.26) | 0.10 (0.05 to 0.14) | 0.25 (0.19 to 0.30) |
Hospital use
| −0.16 (−0.20 to −0.11) | −0.23 (−0.35 to −0.11) | −0.14 (−0.19 to −0.09) |
Costs
| 0.02 (−0.05 to 0.08) | 0.13 (0.02 to 0.24) | −0.04 (−0.12 to 0.04) |