A systematic review of integrated use of disease-management interventions in asthma and COPD

Lemmens, Karin; Nieboer, Anna P.; Huijsman, Robbert

doi:10.1016/j.rmed.2008.11.017

Cited by 118 publications

(118 citation statements)

References 76 publications

(100 reference statements)

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“…Our results support trends found in previous investigations 10,20 and highlight an overall improvement in the quality of care for asthma patients. Therefore, we conclude that since the implementation of the DMP for asthma in Bavaria in 2006, adherence to guidelines, symptom frequency, and pharmacotherapy have improved.…”

Section: Discussionsupporting

confidence: 91%

“…Gibson et al 10 have shown that self-management education for patients with asthma reduces hospitalization, emergency room visits, unscheduled visits to the general practitioner, disability, and nocturnal asthma, while improving the overall quality of life. Additionally, a meta-analysis by Lemmens et al 20 found evidence that multiple interventions led to a significant reduction in hospitalization, in comparison with routine care. The reduction in hospitalization may in turn save costs.…”

Section: Disease Management Programs For Patients With Asthma In Germanymentioning

confidence: 99%

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Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

et al. 2013

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BACKGROUND:The primary aim of the disease management program (DMP) for patients with asthma is to improve health outcomes and to reduce costs. Five years after its introduction in Germany, no consensus has yet been reached as to whether DMP has been effective in reaching these goals. OBJECTIVE: To evaluate the DMP for asthma in Bavaria using routinely collected subject medical records. METHODS: A longitudinal population-based study encompassing over 100,000 DMP participants between 2006 (when the program began) and 2010. RESULTS: The prescription rate of oral corticosteroids dropped from 15.7% in 2006 to 13.6% in 2007, and again from 7.5% in 2008 to 5.9% in 2010 (P < .001). The proportion of subjects with asthma selfmanagement education increased from 4.4% to 23.4% (P < .001). Utilization of an individual asthma action plan increased from 40.3% to 69.3% (P < .001). Hospitalization decreased from 2.8% to 0.7% (P < .001). CONCLUSIONS: In the first 4 years of DMP there was an improvement in pharmacotherapy and patient self management. The proportion of subjects requiring hospitalization decreased. Our results suggest that the German DMP for asthma has been effective in enhancing the quality of care in regard to an improved symptom frequency, adherence to guidelines, pharmacotherapy, and hospitalization.

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Section: Discussionsupporting

confidence: 91%

Section: Disease Management Programs For Patients With Asthma In Germanymentioning

confidence: 99%

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

et al. 2013

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“…A meta-analysis by Lemmens et al 37 found evidence that multiple interventions led to a significant reduction in hospitalization in comparison with routine care. A reduction in hospitalization may in turn save costs.…”

Section: Discussionmentioning

confidence: 99%

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

et al. 2013

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INTRODUCTION:The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. METHODS: A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. RESULTS: The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. CONCLUSIONS: Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.

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“…Previous systematic reviews in patients with COPD have studied self-management education (11,12), integrated care (13)(14)(15), shared management between specialists and primary care physicians (16), and home care (17) in patients with stable COPD, or hospital at home for acutely ill patients with COPD exacerbations (18) or other conditions (19). Previous reviews on care transitions from hospital to home have focused on other patient populations (ie, not patients with COPD exacerbations) (20)(21)(22).…”

mentioning

confidence: 99%

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Prieto-Centurion¹,

Markos

Ramey³

et al. 2014

Annals ATS

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Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

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A systematic review of integrated use of disease-management interventions in asthma and COPD

Abstract: In spite of the heterogeneity of disease management studies in asthma and COPD care, this review showed promising improvements in quality of life and reductions in hospitalisations, especially for triple intervention programmes.

Cited by 118 publications

References 76 publications

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

Disease Management Programs for Patients With Asthma in Germany: A Longitudinal Population-Based Study

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

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