The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation

Loveman, Emma; Cave, Carolyn Backer; Green, C.; Royle, Pamela; Dunn, Nina; Waugh, Norman

doi:10.3310/hta7220

Cited by 135 publications

(114 citation statements)

References 34 publications

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

“…In eight reviews, experts in the field were contacted to identify additional publications [10,11,13,15,[18][19][20]25]. Reference tracking was performed in 11 reviews [10,11,13,15,16,[18][19][20][21][22]24].…”

Section: Resultsmentioning

confidence: 99%

“…In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25]. Out of 25 [5, 33-37, 39, 41-43, 45-59] replication trials (phase 4, see text box: Phases of 'increasing evidence of complex interventions') four [34,35,39,46] were included in six reviews [16,19,21,22,24,25].…”

Section: Resultsmentioning

confidence: 99%

“…In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25]. Out of 25 [5, 33-37, 39, 41-43, 45-59] replication trials (phase 4, see text box: Phases of 'increasing evidence of complex interventions') four [34,35,39,46] were included in six reviews [16,19,21,22,24,25]. Different reviews on identical topics included different publications referring to the same reference programme.…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews.Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed metaanalysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA 1c was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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“…From the available literature, the effectiveness of educational interventions and the clinical relevance of the benefits are still unclear [20,24,25]. Patient education has two major drawbacks: Firstly, its statistically significant benefits are modest.…”

Section: Patient Education: Effectiveness and Clinical Relevancementioning

confidence: 99%

Patient information and education with modern media: the Spine Society of Europe Patient Line

Pellisé¹,

Sell

2009

Eur Spine J

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The role of the patient as an active partner in health care, and not just a passive object of diagnostic testing and medical treatment, is widely accepted. Providing information to patients is considered a crucial issue and the central focus in patient educational activities. It is necessary to educate patients on the nature of the outcomes and the benefits and risks of the procedures to involve them in the decision-making process and enable them to achieve fully informed consent. Information materials must contain scientifically reliable information and be presented in a form that is acceptable and useful to patients. Given the mismatch between public beliefs and current evidence, strategies for changing the public perceptions are required. Traditional patient education programmes have to face the potential barriers of storage, access problems and the need to keep content materials up to date. A computer-based resource provides many advantages, including ''just-intime'' availability and a private learning environment. The use of the Internet for patient information needs will continue to expand as Internet access becomes readily available. However, the problem is no longer in finding information, but in assessing the credibility and validity of it. Health Web sites should provide health information that is secure and trustworthy. The large majority of the Web sites providing information related to spinal disorders are of limited and poor quality. Patient Line (PL), a patient information section in the Web site of Eurospine, was born in 2005 to offer patients and the general population the accumulated expertise represented by the members of the society and provide up-to-date information related to spinal disorders. In areas where evidence is scarce, Patient Line provides a real-time opinion of the EuroSpine membership. The published data reflect the pragmatic and the common sense range of treatments offered by the Eurospine membership. The first chapters have been dedicated to sciatica, scoliosis, cervical pain syndromes, low back pain and motion preservation surgery. Since 2008, the information has been available in English, German, French and Spanish. The goal is for Patient Line to become THE European patient information Web site on spinal disorders, providing reliable and updated best practice and evidence-based information where the evidence exists.

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Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

Vermeire

Wens

Royen

et al. 2005

Cochrane Database of Systematic Reviews

199

121

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BackgroundResearch suggests adherence to treatment recommendations is low. In type 2 diabetes, which is a chronic condition slowly leading to serious vascular, nephrologic, neurologic and ophthalmological complications, it can be assumed that enhancing adherence to treatment recommendations may lead to a reduction of complications. Treatment regimens in type 2 diabetes are complicated, encompassing lifestyle adaptations and medication intake. ObjectivesTo assess the effects of interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Search methodsStudies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references. Selection criteriaRandomised controlled and controlled clinical trials, before-after studies and epidemiological studies, assessing changes in adherence to treatment recommendations, as defined in the objectives section, were included. Data collection and analysisTwo teams of reviewers independently assessed the trials identified for inclusion. Three teams of two reviewers assessed trial quality and extracted data. The analysis for the narrative part was performed by one reviewer (EV), the meta-analysis by two reviewers (EV, JW). Main resultsTwenty-one studies assessing interventions aiming at improving adherence to treatment recommendations, not to diet or exercise recommendations, in people living with type 2 diabetes in primary care, outpatient settings, community and hospital settings, were included. Outcomes evaluated in these studies were heterogeneous, there was a variety of adherence measurement instruments. Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c. No data on mortality and morbidity, nor on quality of life could be found. 1 Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus (Review)

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The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation

Cited by 135 publications

References 34 publications

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

Patient information and education with modern media: the Spine Society of Europe Patient Line

Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

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