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Publisher: BIOMED CENTRAL LTD
Journal: BMC Health Services Research
Types: Article
Subjects: Long-term conditions, Health outcomes, Costs, Systematic review, Quality of life, Meta-analysis, RA, Self-management support interventions, Health care utilization, Hospitalizations, Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Self-management support interventions, Long-term conditions, Health outcomes, Quality of life, Health care utilization, Hospitalizations, Costs, Cost-effectiveness, Systematic review, Meta-analysis, RANDOMIZED CONTROLLED-TRIAL, LONG-TERM CONDITIONS, QUALITY-OF-LIFE, CHRONIC DISEASE, META-REGRESSION, PROGRAM, BIAS, MULTIMORBIDITY, DEPRESSION, EDUCATION, Cost-effectiveness, Research Article
Background There is increasing interest in the role of ‘self-management’ interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. Methods We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. Results We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems. Studies at higher risk of bias were more likely to report benefits. Conclusions Self-management support interventions can reduce health service utilization without compromising patient health outcomes, although effects were generally small, and the evidence was strongest in respiratory and cardiovascular disorders. Further work is needed to determine which components of self-management support are most effective. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-356) contains supplementary material, which is available to authorized users.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Murray C, Lopez A: The global burden of disease: a comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990. Boston: Harvard University Press; 1996.
    • 2. Barnett B, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B: The epidemiology of multimorbidity in a large cross-sectional dataset: implications for health care, research and medical education. Lancet 2012, 380:37-43.
    • 3. Epping-Jordan J, Pruitt S, Bengoa R, Wagner E: Improving the quality of health care for chronic conditions. Qual Saf Health Care 2004, 13:299-305.
    • 4. Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, Parker S, Roland M: Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ 2007, 334:31.
    • 5. Roland M, Abel G: Reducing emergency admissions: are we on the right track? BMJ 2012, 345:e6017.
    • 6. Clark N, Becker M, Janz N, Lorig K, Rawkowski W, Anderson L: Self management of chronic disease by older adults: a review and questions for research. J Aging Health 1991, 3:3-27.
    • 7. Coulter A, Ellis J: Effectiveness of strategies for informing, educating and involving patients. BMJ 2007, 335:24-27.
    • 8. Barlow J, Singh D, Bayer S, Curry R: A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. J Telemed Telecare 2007, 13:172-179.
    • 9. Murray E, Burns J, See Tai S, Lai R, Nazareth I: Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev 2005, (4). Art. No.: CD004274. doi:10.1002/14651858.CD004274.pub4.
    • 10. DAFNE Study Group: Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002, 325:746-751.
    • 11. Davies M, Heller S, Skinner T, Campbell M, Carey M, Cradock S, Dallosso H, Daly H, Doherty Y, Eaton S, Fox C, Oliver L, Rantell K, Rayman G, Khunti K: Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008, 336:491-495.
    • 12. Rogers A, Kennedy A, Bower P, Gardner C, Gately C, Lee V, Reeves D, Richardson G: The United Kingdom Expert Patients Programme: results and implications from a national evaluation. Med J Aust 2008, 189:S21-S24.
    • 13. Kennedy A, Rogers A, Bower P: Support for self care for patients with chronic disease. BMJ 2007, 335:968-970.
    • 14. Wanless D: Securing our Future Health: taking a long term view. London: HM Treasury; 2002.
    • 15. Lorig K, Sobel D, Stewart A, Brown B, Bandura A, Ritter P, Gonzalez V, Laurent D, Holman H: Evidence suggesting that chronic disease self management can improve health status while reducing hospitalisation: a randomized trial. Med Care 1999, 37:5-14.
    • 16. Griffiths C, Foster G, Ramsay J, Eldridge S, Taylor S: How effective are expert patient (lay led) education programmes for chronic disease? BMJ 2007, 334:1254-1256.
    • 17. Salisbury C, Chalder M, Scott T, Pope C, Moore L: What is the role of walk-in centres in the NHS? BMJ 2002, 324:399.
    • 18. Donaldson C, Currie G, Mitton C: Cost effectiveness analysis in health care: contraindications. BMJ 2002, 325:891-894.
    • 19. Tsiligiannia I, Kocks J, Tzanakis N, Siafakas N, van der Molen T: Factors that influence disease-specific quality of life or health status in patients with COPD: a systematic review and meta-analysis of Pearson correlations. Primary Care Respir J 2011, 20:257-268.
    • 20. Schulz K, Chalmers I, Hayes R, Altman D: Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995, 273:408-412.
    • 21. Pildal J, Hróbjartsson A, Jørgensen K, Altman D, Gøtzsche P: Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. Int J Epidemiol 2007, 36:847-857.
    • 22. Lipsey M, Wilson D: Practical Meta-Analysis. Newbury Park: Sage; 2001.
    • 23. Altman D, Bland J: Detecting skewness from summary information. BMJ 1996, 313:1200.
    • 24. Dieterich M, Irving C, Park B, Marshall M: Intensive case management for severe mental illness. Cochrane Database Syst Rev 2010, (10). Art. No.: CD007906. doi:10.1002/14651858. CD007906.pub2.
    • 25. Higgins J, Green S: Cochrane handbook for systematic reviews of interventions (version 5.0.1). Cochrane Collaboration 2009. http://www. cochrane-handbook.org/.
    • 26. Higgins J, Thompson S, Deeks J, Altman D: Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
    • 27. Nixon J, Khan K, Kleijnen J: Summarising economic evaluations in systematic reviews: a new approach. BMJ 2001, 322:1596-1598.
    • 28. Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ 1997, 315:629-634.
    • 29. Sterne J, Egger M: Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001, 54:1046-1055.
    • 30. Smith S, Soubhi H, Fortin M, Hudon C, O'Dowd T: Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 2012, 345:e5205.
    • 31. Harrison M, Reeves D, Harkness E, Valderas J, Kennedy A, Rogers A, Hann M, Bower P: A secondary analysis of the moderating effects of depression and multimorbidity on the effectiveness of a chronic disease self-management programme. Pat Educ Couns 2012, 87:67-73.
    • 32. Vassilev I, Rogers A, Sanders C, Kennedy A, Blickem C, Protheroe J, Bower P, Kirk S, Chew-Graham C, Morris R: Social networks, social capital and chronic illness self-management: a realist review. Chronic Illness 2011, 7:60-86.
    • 33. Bower P, Gilbody S, Richards D, Fletcher J, Sutton A: Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta regression. Br J Psychiatry 2006, 189:484-493.
    • 34. Gellatly J, Bower P, Hennessey S, Richards D, Gilbody S, Lovell K: What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med 2007, 37:1217-1228.
    • 35. Paddison C, Roland M: Better management of patients with multimorbidity. BMJ 2013, 346:f2510.
    • 36. Bayliss E, Steiner J, Fernald D, Crane L, Main D: Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med 2003, 1:15-21.
    • 37. Bayliss E, Ellis J, Steiner J: Barriers to self management and quality of life outcomes in seniors with multimorbidities. Ann Fam Med 2007, 5:395-402.
    • 38. O'Brien R, Wyke S, Guthrie S, Watt G, Mercer S: An 'endless struggle': a qualitative study of general practitioners' and practice nurses' experience of managing multimorbidity in socio-economically deprived area of Scotland. Chronic Illness 2011, 7:59.
    • 39. Purdy S, Paranjothy S, Huntley A, Thomas R, Mann M, Huws D, Brindle P, Elwyn G: Interventions to reduce unplanned hospital admission: a series of systematic reviews (final report June 2012). 2013. http://www.bristol.ac. uk/primaryhealthcare/docs/projects/unplannedadmissions.pdf.
    • 40. Wennberg D, Marr A, Lang L, O'Malley S, Bennett G: A randomized trial of a telephone care-management strategy. N Engl J Med 2010, 363:1245-1255.
    • 41. Kennedy A, Bower P, Reeves D, Blakeman T, Bowen R, Chew-Graham C, Eden M, Fullwood C, Gaffney H, Gardner C, Lee V, Morris R, Protheroe J, Richardson G, Sanders C, Swallow A, Thompson D, Rogers A: Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial. BMJ 2013, 346:f2882.
    • 42. Rogers A, Elliott H: Primary Care: Understanding Health Need and Demand. Guildford: Radcliffe; 1997.
    • 43. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: new guidance. London: Medical Research Council; 2008.
    • 44. Fisher E, Brownson C, O'Toole M, Shetty G, Anwuri V, Glasgow R: Ecological approaches to self management: the case of diabetes. Am J Public Health 2005, 95:1523-1535.
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    The results below are discovered through our pilot algorithms. Let us know how we are doing!

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