eprintid: 10040877
rev_number: 26
eprint_status: archive
userid: 608
dir: disk0/10/04/08/77
datestamp: 2018-01-05 09:32:02
lastmod: 2021-12-06 00:20:01
status_changed: 2018-01-05 09:32:02
type: article
metadata_visibility: show
creators_name: Pinnock, H
creators_name: Parke, HL
creators_name: Panagioti, M
creators_name: Daines, L
creators_name: Pearce, G
creators_name: Epiphaniou, E
creators_name: Bower, P
creators_name: Sheikh, A
creators_name: Griffiths, CJ
creators_name: Taylor, SJC
creators_name: PRISMS and RECURSIVE groups, 
title: Systematic meta-review of supported self-management for asthma: a healthcare perspective
ispublished: pub
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: D12
divisions: G20
keywords: Supported self-management, Asthma, Systematic meta-review, Health economic analysis, Meta-analysis
note: Copyright © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
abstract: BACKGROUND: Supported 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. 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: A 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). CONCLUSIONS: Evidence 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.
date: 2017-03-17
date_type: published
official_url: http://doi.org/10.1186/s12916-017-0823-7
oa_status: green
full_text_type: pub
pmcid: PMC5356253
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1519715
doi: 10.1186/s12916-017-0823-7
pii: 10.1186/s12916-017-0823-7
lyricists_name: Murray, Elizabeth
lyricists_name: Newman, Stanton
lyricists_id: EMURR90
lyricists_id: SPNEW17
actors_name: Waragoda Vitharana, Nimal
actors_id: NWARR44
actors_role: owner
full_text_status: public
publication: BMC Medicine
volume: 15
number: 1
article_number: 64
event_location: England
issn: 1741-7015
citation:        Pinnock, H;    Parke, HL;    Panagioti, M;    Daines, L;    Pearce, G;    Epiphaniou, E;    Bower, P;                 ... PRISMS and RECURSIVE groups; + view all <#>        Pinnock, H;  Parke, HL;  Panagioti, M;  Daines, L;  Pearce, G;  Epiphaniou, E;  Bower, P;  Sheikh, A;  Griffiths, CJ;  Taylor, SJC;  PRISMS and RECURSIVE groups;   - view fewer <#>    (2017)    Systematic meta-review of supported self-management for asthma: a healthcare perspective.                   BMC Medicine , 15  (1)    , Article 64.  10.1186/s12916-017-0823-7 <https://doi.org/10.1186/s12916-017-0823-7>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10040877/1/s12916-017-0823-7.pdf