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

Abstract

BackgroundSupported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (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; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management.MethodsWe 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.ResultsA total of 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 delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval −0.09 to 0.34).ConclusionsEvidence from a total of 270 RCTs confirms 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.Systematic review registrationRECURSIVE: PROSPERO CRD42012002694; PRISMS: PROSPERO does not register meta-reviewsElectronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0823-7) contains supplementary material, which is available to authorized users.

Evaluation of a diagnostic therapeutic educational pathway for asthma management in youth

“…Evidence from controlled clinical trials shows that asthma control can be substantially improved by self‐management, a core component of which is patient's education, although some differences have been noted according to type of approach, outcomes assessed and program providers . An Italian trial showed that an educational program for children with asthma reduced the number of asthma attacks and improved knowledge of the disease .…”

“…5,6 In a recent systematic meta-review, self-management of asthma, a core component of which was patient's education, improved asthma control and reduced hospitalizations and emergency attendances. 7 A systematic review of randomized clinical trials found that about the half of educational and behavioral interventions achieved reduction in the use of health care and one-third in symptom control. 8 In spite of the evidence of the positive effects of education of asthmatic patients to self-management of their disease, there is still poor assessment of the impact of patients' educational programs on asthma control in the real world.…”

“…In a recent systematic meta‐review, self‐management of asthma, a core component of which was patient's education, improved asthma control and reduced hospitalizations and emergency attendances . A systematic review of randomized clinical trials found that about the half of educational and behavioral interventions achieved reduction in the use of health care and one‐third in symptom control…”

Strategies to promote adoption and usage of an application to support asthma self-management: a qualitative observational study

“…It can be controlled by medications, but is ideally managed in the context of supported self-management, with an asthma action plan provided by clinicians explaining what to do when symptoms are worsening. However, few asthma patients have an asthma action plan2 despite overwhelming evidence that supported self-management improves asthma outcomes 3. Asthma action plans are usually paper-based but are easily mislaid.…”

Mobile health tools for the management of chronic respiratory diseases

“…Two‐thirds of the evaluated apps provide patient feedback via a graph visualizing the degree of symptoms over time, whereas only 10% of apps provide patient feedback through an AP. Self‐management, including self‐monitoring of symptoms and/or lung function with patient feedback through an individualized written AP, has been advocated for many years for patients with asthma . A systematic meta‐review of supported self‐management tools for asthma now confirms its effectiveness without increase of total healthcare costs .…”