The online version of this article (doi:10.1186/s12916-017-0823-7) contains supplementary material, which is available to authorized users.
Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management.
We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis.
A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval −0.09 to 0.34).
Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care.
RECURSIVE: PROSPERO CRD42012002694; PRISMS: PROSPERO does not register meta-reviews
Additional file 1: Detailed search terms: PRISMS and RECURSIVE (all databases). (DOCX 88 kb)12916_2017_823_MOESM1_ESM.docx
Additional file 2: Dates of initial and update searches. (DOCX 21 kb)12916_2017_823_MOESM2_ESM.docx
Additional file 3: Detailed PICOS table and inclusion/exclusion criteria. (DOCX 22 kb)12916_2017_823_MOESM3_ESM.docx
Additional file 4: Quality assessment and weighting. (DOCX 43 kb)12916_2017_823_MOESM4_ESM.docx
Additional file 5: Characteristics of included studies and key outcomes. (DOCX 169 kb)12916_2017_823_MOESM5_ESM.docx
Global Asthma Network. The global asthma report 2014. Global Asthma Network. 2014. http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf. Accessed 22 Dec 2016
British Thoracic Society, Research Unit of the Royal College of Physicians of London, King’s Fund Centre. National Asthma Campaign. Guidelines for management of asthma in adults: I-chronic persistent asthma. BMJ. 1990;301:651–3. CrossRef
British Thoracic Society/Scottish Intercollegiate Guideline Network. British guideline on the management of asthma. 2016 update. http://sign.ac.uk/guidelines/fulltext/153/index.html. Accessed 22 Dec 2016.
Global Initiative for Asthma. Global strategy for asthma management and prevention 2015 update. http://www.ginasthma.org. Accessed 22 Dec 2016.
Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report. London: Royal College of Physicians; 2014.
Singh D, Ham C. Improving care for people with long-term conditions: a review of UK and international frameworks. NHS Institute for Innovation and Improvement. Department of Health: Birmingham; 2006.
World Health Organization. Innovative care for chronic conditions. Building blocks for action. Global report. Geneva: WHO; 2002.
Department of Health. The Mandate. A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015. London: Department of Health; 2012.
Asthma UK. Time to take action on asthma. London: Asthma UK; 2014.
Taylor SJC, Pinnock H, Epiphaniou E, Pearce G, Parke H. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions. (PRISMS Practical Systematic Review of Self-Management Support for long-term conditions). Health Serv Deliv Res. 2014;2:54. CrossRef
Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, et al. Reducing care utilisation through self-management interventions (RECURSIVE): a systematic review and meta-analysis. Health Serv Deliv Res. 2014;2:54. CrossRef
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 http://handbook.cochrane.org. Accessed 22 Dec 2016.
Adams K, Greiner AC, Corrigan JM, editors. The 1st annual crossing the quality chasm summit – a focus on communities. Washington, D.C: The National Academic Press; 2004. p. 57.
Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, et al. From systematic reviews to clinical recommendations for evidence-based health care: validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J. 2010;4:84–91. PubMedPubMedCentral
Drummond MF, O’Brien, Stoddart LG, Torrance GW. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press; 1997.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
Bhogal SK, Zemek RL, Ducharme F. Written action plans for asthma in children. Cochrane Database Syst Rev. 2006;3, CD005306. doi: 10.1002/14651858.CD005306.pub2.
Bailey EJ, Cates CJ, Kruske SG, Morris PS, Brown N, Chang AB. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2009;2, CD006580. doi: 10.1002/14651858.CD006580.pub4.
Boyd M, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M. Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database Syst Rev. 2009;2, CD001290. doi: 10.1002/14651858.CD001290.pub2.
Chang AB, Taylor B, Masters IB, Laifoo Y, Brown ADH. Indigenous healthcare worker involvement for Indigenous adults and children with asthma. Cochrane Database Syst Rev. 2010;5, CD006344. doi: 10.1002/14651858.CD006344.pub3.
Gibson PG, Powell H, Wilson A, Abramson MJ, Haywood P, Bauman A, et al. Self management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2002;3, CD001117. doi: 10.1002/14651858.CD001117.
Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2002;3, CD004107. doi: 10.1002/14651858.CD004107.
Tapp S, Lasserson TJ, Rowe BH. Education interventions for adults who attend the emergency room for acute asthma. Cochrane Database Syst Rev. 2007;3:CD003000. doi: 10.1002/14651858.CD003000.pub2.
Toelle B, Ram FSF. Written individualised management plans for asthma in children and adults. Cochrane Database Syst Rev. 2004;1, CD002171. doi: 10.1002/14651858.CD002171.pub2.
Welsh EJ, Hasan M, Li P. Home-based educational interventions for children with asthma. Cochrane Database Syst Rev. 2011;10, CD008469. doi: 10.1002/14651858.CD008469.pub2.
Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev. 2013;11, CD010013. doi: 10.1002/14651858.CD010013.pub2.
Press VG, Pappalardo AA, Conwell WD, Pincavage AT, Prochaska MH, Arora VM. Interventions to improve outcomes for minority adults with asthma: a systematic review. J Gen Int Med. 2012;27:1001–15. CrossRef
Baptist AP, Ross JA, Yang Y, Song PXK, Clark NM. A randomized controlled trial of a self-regulation intervention for older adults with asthma. J Am Geriatrics Soc. 2013;61:747–53. CrossRef
Goeman D, Jenkins C, Crane M, Paul E, Douglass J. Educational intervention for older people with asthma: a randomised controlled trial. Pat Ed Counsel. 2013;93:586–95. CrossRef
Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, et al. Randomized controlled trial to improve care for urban children with asthma: results of the school-based asthma therapy trial. Arch Pediatric Adolesc Med. 2011;165:262–8. CrossRef
Wong SS, Nathan AM, de Bruyne J, Zaki R, Tahir SZM. Does a written asthma action plan reduce unscheduled doctor visits in children? Indian J Pediatr. 2011;80:590–5. CrossRef
Coelho AC, Cardoso LS, Machado CS, Machado AS. The impacts of educational asthma interventions in schools: a systematic review of the literature. Can Respir J. 2016;2016:8476206.
Hoskins G, Williams B, Abhyankar P, Donnan P, Duncan E, Pinnock H, et al. Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma. Trials. 2016;17:584. CrossRefPubMedPubMedCentral
Rice JL, Matlack KM, Simmons MD, Steinfeld J, Laws MA, Dovey ME, et al. LEAP: A randomized-controlled trial of a lay-educator inpatient asthma education program. Pat Ed Counsel. 2015;98:1585–91. CrossRef
McLean W, Gillis J, Waller R. The BC Community Pharmacy Asthma Study: a study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Canadian Respir J. 2003;10:195–202. CrossRef
Ring N, Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, et al. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Pat Ed Counsel. 2011;85:e131–43. CrossRef
Marshall IJ, Wolfe CDA, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012;344, e3953. CrossRef
Ayling K, Brierley S, Johnson B, Heller S, Eiser C. How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes. Psychol Health. 2015;3:85–103. CrossRef
- Systematic meta-review of supported self-management for asthma: a healthcare perspective
Hannah L. Parke
Chris J. Griffiths
Stephanie J. C. Taylor
for the PRISMS and RECURSIVE groups
- BioMed Central
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