Abstract
Problem: 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 utilisation and improving quality of life (QoL).
Approach: 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. The primary outcomes include healthcare utilisation (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, inconstancy and publication bias were assessed.
Findings: From 1,178 citations we included 105 trials comprising 27,767 participants. In terms of healthcare utilisation, 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 utilisation: 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 utilisation in patients with symptoms of severe asthma at baseline.
Consequences: 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. Future research and policy investments need to focus on implementing regularly supported self-management, targeting multi-disciplinary case management on those with complex disease.
Funding Acknowledgement: Study is funded by the National Institute for Health Research School for Primary Care Research (project 269)
Approach: 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. The primary outcomes include healthcare utilisation (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, inconstancy and publication bias were assessed.
Findings: From 1,178 citations we included 105 trials comprising 27,767 participants. In terms of healthcare utilisation, 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 utilisation: 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 utilisation in patients with symptoms of severe asthma at baseline.
Consequences: 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. Future research and policy investments need to focus on implementing regularly supported self-management, targeting multi-disciplinary case management on those with complex disease.
Funding Acknowledgement: Study is funded by the National Institute for Health Research School for Primary Care Research (project 269)
| Original language | English |
|---|---|
| Title of host publication | Society for Academic Primary Care |
| Subtitle of host publication | Living & Dying Well 49th Annual Scientific Meeting of SAPC |
| Place of Publication | https://sapc.ac.uk/doi/10.37361/asm.2020.1.1 |
| Publication status | E-pub ahead of print - 8 Jun 2020 |
