Complex interventions reduce use of urgent healthcare in adults with asthma: Systematic review with meta-regression

Blakemore, Amy; Anderson, Rebecca J.; Tomenson, Barbara; Woodcock, Ashley; Guthrie, Elspeth

doi:10.1016/j.rmed.2014.11.002

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…Meta-regression can be used for this, using covariates to code the presence of particular features in each intervention implementation. As an example, Blakemore et al analysed 39 intervention comparisons from 33 independent studies aiming to reduce urgent healthcare use in adults with asthma 52. Effect size estimates were coded according to components used in the interventions, and the authors found that multicomponent interventions including skills training, education and relapse prevention appeared particularly effective.…”

Section: Synthesis Methods For Understanding Components Of the Intervmentioning

confidence: 99%

Synthesising quantitative evidence in systematic reviews of complex health interventions

et al. 2019

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Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available.

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Section: Synthesis Methods For Understanding Components Of the Intervmentioning

confidence: 99%

Synthesising quantitative evidence in systematic reviews of complex health interventions

et al. 2019

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“…Meta‐regression for core component analysis—or “unpacking the black box” as some call it (Solmeyer & Constance, 2015)—is widely used across many policy areas, including health (Filene et al, 2013), prevention services (Wilson et al, 2020), education (Farrington & Ttofi, 2009), and workforce development (Bloom et al, 2003). Blakemore and others (2014) used meta‐regression as part of their examination of core components in a broad range of interventions for people with asthma in order to identify the characteristics that were associated with a reduction in the use of urgent health care. The interventions were grouped according to program approaches and coded for general and specific core components, study design features, target group characteristics, and contextual conditions, among other aspects.…”

Section: The Three Waves Of Evidence Reviewsmentioning

confidence: 99%

The evolution of systematic evidence reviews: Past and future developments and their implications for policy analysis

2023

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Evidence reviews are widely used to summarize findings from existing studies and, as such, are an important base for policy analysis. Over the past 50 years, three waves of evidence reviews have emerged: (1) the meta‐analysis wave, (2) the mixed‐methods synthesis wave, and (3) the core components wave. The present article first describes these waves and reflects on the benefits and limitations of each wave in the context of policy analysis. Informed by this historical account, the article then identifies and discusses three trends that are likely to influence future directions of evidence reviews: (1) using data science tools, (2) embedding an equity focus, and (3) translating research into practice. The concluding discussion connects these developments to public policy, identifying how evidence from systematic evidence reviews informs—or could better inform—policy decisions. Related Articles Nunes Silva, Carlos. 2012. “Policy and Evidence in a Partisan Age: The Great Disconnect—By Paul Gary Wyckoff.” Politics & Policy 40(3): 541–43. https://doi.org/10.1111/j.1747-1346.2012.00363.x. Sinclair, Thomas A. P. 2006. “Previewing Policy Sciences: Multiple Lenses and Segmented Visions.” Politics & Policy 34(3): 481–504. https://doi.org/10.1111/j.1747-1346.2006.00025.x. Smith‐Walter, Aaron, Holly L. Peterson, Michael D. Jones, and Ashley Nicole Reynolds Marshall. 2016. “Gun Stories: How Evidence Shapes Firearm Policy in the United States.” Politics & Policy 44(6): 1053–88. https://doi.org/10.1111/polp.12187.

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“…One of the reviews focused on asthma 112 and the other on COPD. 111 The similarity of the results from these two reviews (> 60 studies), coupled with published data on other LTCs, 320,[365][366][367] suggests that psychosocial interventions may have similar effects in LTCs, regardless of the individual nature of the condition itself.…”

Section: Long-term Conditions and Multimorbiditymentioning

confidence: 99%

“…111,112,333,365,366 Treatment of psychosocial problems may provide an added dimension to the overall care of people with LTCs, which has been relatively neglected to date.…”

Section: Reasons Why People With Long-term Conditions Use Unscheduledmentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Complex interventions reduce use of urgent healthcare in adults with asthma: Systematic review with meta-regression

Abstract: Complex interventions reduced the use of urgent healthcare in adults with asthma by 21%. Those complex interventions including skills training, education and relapse prevention may be particularly effective in reducing the use of urgent healthcare in adults with asthma.

Cited by 6 publications

References 30 publications

Synthesising quantitative evidence in systematic reviews of complex health interventions

Synthesising quantitative evidence in systematic reviews of complex health interventions

The evolution of systematic evidence reviews: Past and future developments and their implications for policy analysis

CHOICE: Choosing Health Options In Chronic Care Emergencies

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