Abstract
Background: Asthma is one of the most common chronic conditions worldwide. Guidelines for treating asthma recommend the use of self-management interventions. However, it is unclear which self-management models are most effective at reducing healthcare utilization and improving quality of life (QoL).
Methods: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials to compare the effects of three different Self-management intervention models (multi-disciplinary case-management, regularly-supported self-management and minimally-supported self-management) and self-monitoring models, against usual care and education. We searched MEDLINE, the Cochrane library, CINAHL, EconLit, EMBASE, Health Economics Evaluations Database, NHS Economic Evaluation Database, PsycINFO and ClinicalTrials.gov for published and unpublished trials from January 2000 to April 2019. We assessed risk of bias in accordance to the Cochrane Handbook and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The primary outcomes include healthcare utilization (i.e. hospitalisation or emergency visit) and QoL. Summary standardised mean differences (SMDs) and 95% credible intervals (95%CrI) were estimated using Bayesian NMA with random-effects. Heterogeneity was quantified with heterogeneity-variance (τ2) and through inconsistency analysis. Publication bias was assessed with funnel plots. This study is registered with PROSPERO, number CRD42019121350.
Results: From 1,178 citations we included 105 trials comprising 27,767 participants. In terms of healthcare utilization, both multi-disciplinary case-management (SMD=-0.18, 95%CrI: -0.32 to -0.05) and regularly-supported self-management (SMD=-0.30, 95%CrI: -0.46 to -0.15) were significantly better than usual care. For QoL, only regularly-supported self-management (SMD = 0.54, 95% CrI: 0.11 to 0.96) showed a statistically significant increase when compared to usual care. For trials including adolescents/children (aged 5-18 years), only regularly-supported self-management showed statistically significant benefits (healthcare utilization: SMD=-0.21, 95%CrI: -0.40 to -0.03; QoL: SMD=0.23, 95% CrI: 0.03 to 0.48). Multi-disciplinary case-management (SMD=-0.32, 95%CrI: -0.50 to -0.16) and regularly-supported-self-management (SMD=-0.32, 95%CrI: -0.53, -0.11) were most effective at reducing healthcare utilization in patients with symptoms of severe asthma at baseline.
Implications: This is the largest study to use NMA to assess the relative merits of different models of self-management in the treatment of asthma. We conclude that regularly-supported self-management is the most optimal intervention model for improving healthcare utilisation and QoL.
Methods: We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials to compare the effects of three different Self-management intervention models (multi-disciplinary case-management, regularly-supported self-management and minimally-supported self-management) and self-monitoring models, against usual care and education. We searched MEDLINE, the Cochrane library, CINAHL, EconLit, EMBASE, Health Economics Evaluations Database, NHS Economic Evaluation Database, PsycINFO and ClinicalTrials.gov for published and unpublished trials from January 2000 to April 2019. We assessed risk of bias in accordance to the Cochrane Handbook and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The primary outcomes include healthcare utilization (i.e. hospitalisation or emergency visit) and QoL. Summary standardised mean differences (SMDs) and 95% credible intervals (95%CrI) were estimated using Bayesian NMA with random-effects. Heterogeneity was quantified with heterogeneity-variance (τ2) and through inconsistency analysis. Publication bias was assessed with funnel plots. This study is registered with PROSPERO, number CRD42019121350.
Results: From 1,178 citations we included 105 trials comprising 27,767 participants. In terms of healthcare utilization, both multi-disciplinary case-management (SMD=-0.18, 95%CrI: -0.32 to -0.05) and regularly-supported self-management (SMD=-0.30, 95%CrI: -0.46 to -0.15) were significantly better than usual care. For QoL, only regularly-supported self-management (SMD = 0.54, 95% CrI: 0.11 to 0.96) showed a statistically significant increase when compared to usual care. For trials including adolescents/children (aged 5-18 years), only regularly-supported self-management showed statistically significant benefits (healthcare utilization: SMD=-0.21, 95%CrI: -0.40 to -0.03; QoL: SMD=0.23, 95% CrI: 0.03 to 0.48). Multi-disciplinary case-management (SMD=-0.32, 95%CrI: -0.50 to -0.16) and regularly-supported-self-management (SMD=-0.32, 95%CrI: -0.53, -0.11) were most effective at reducing healthcare utilization in patients with symptoms of severe asthma at baseline.
Implications: This is the largest study to use NMA to assess the relative merits of different models of self-management in the treatment of asthma. We conclude that regularly-supported self-management is the most optimal intervention model for improving healthcare utilisation and QoL.
| Original language | English |
|---|---|
| Title of host publication | EBHC conference 2019 |
| Subtitle of host publication | THe Ecosystem of evidence |
| Publisher | ebhc conference 2019 |
| Publication status | Published - 2 Nov 2019 |
