Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis

BMC Health Services Research

Peter Bower²  Stanton Newman⁵  Anne Kennedy⁴  Anne Rogers⁴  Elizabeth Murray¹  Nicola Small²  Gerry Richardson³  Maria Panagioti² 

[1] Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London NW3 2PF, UK;School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK;Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK;Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK;School of Health Sciences, City University London, 1 Myddleton Street, London, EC1V 0HB, UK

关键词: Meta-analysis;    Systematic review;    Cost-effectiveness;    Costs;    Hospitalizations;    Health care utilization;    Quality of life;    Health outcomes;    Long-term conditions;    Self-management support interventions;   

Others  :  1126683
DOI  :  10.1186/1472-6963-14-356

 received in 2014-01-17, accepted in 2014-07-29,  发布年份 2014

【 摘 要 】

Background

There is increasing interest in the role of ‘self-management’ interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions.

Methods

We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses.

Results

We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems. Studies at higher risk of bias were more likely to report benefits.

Conclusions

Self-management support interventions can reduce health service utilization without compromising patient health outcomes, although effects were generally small, and the evidence was strongest in respiratory and cardiovascular disorders. Further work is needed to determine which components of self-management support are most effective.

【 授权许可】

   
2014 Panagioti et al.; licensee BioMed Central Ltd.

【 图 表 】

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