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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Medicine 1/2017

Systematic meta-review of supported self-management for asthma: a healthcare perspective

Zeitschrift:
BMC Medicine > Ausgabe 1/2017
Autoren:
Hilary Pinnock, Hannah L. Parke, Maria Panagioti, Luke Daines, Gemma Pearce, Eleni Epiphaniou, Peter Bower, Aziz Sheikh, Chris J. Griffiths, Stephanie J. C. Taylor, for the PRISMS and RECURSIVE groups
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12916-017-0823-7) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Systematic review registration

RECURSIVE: PROSPERO CRD42012002694; PRISMS: PROSPERO does not register meta-reviews
Zusatzmaterial
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
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