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

Background: Supported self-management has been recommended by asthma guidelines for three decades; improving current sub-optimal implementation will require commitment from professionals, patients and healthcare organisations. The PRISMS meta-review and 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, which components, and which 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: 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 livered in the context of proactive long-term condition management. 93 The total cost (n=24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and A&E visits (standard mean difference 0.13 (95%CI -0.09 to 0.34)). Conclusions: Evidence from a total of 270 RCTs confirm 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.