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

Hilary Pinnock, Hannah L. Parke, Maria Panagioti, Luke Daines, Gemma Pearce, Eleni Epiphaniou, Peter Bower, Aziz Sheikh, Chris J. Griffiths, Stephanie J. C. Taylor

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    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.
    Original languageEnglish
    Article number64
    JournalBMC Medicine
    Volume15
    DOIs
    Publication statusPublished - 17 Mar 2017

    Bibliographical note

    This paper is in press. It has been accepted for publication in BMC Medicine, which is an open access publication.
    Creative Commons Attribution License

    Keywords

    • supported self-management
    • asthma
    • systematic meta-review
    • health
    • 65 economic analysis
    • meta-analysis

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    Pinnock, H., Parke, H. L., Panagioti, M., Daines, L., Pearce, G., Epiphaniou, E., ... Taylor, S. J. C. (2017). Systematic meta-review of supported self-management for asthma: A healthcare perspective. BMC Medicine, 15, [64]. https://doi.org/10.1186/s12916-017-0823-7