Self-management support interventions improve patient quality of life and reduce use of hospital care for patients with long-term respiratory and cardiovascular conditions

Panagioti M, Richardson G, Murray E, et al.  Reducing care utilisation through self-management interventions (RECURSIVE): A systematic review and meta-analysis  Health Services and Delivery Research. December 2014;2(54).

Review question

Are self-management support interventions for people with long-term conditions effective at reducing use of hospital care and improving patient quality of life?

Background

Self-management involves patients learning to support their health and well-being through adopting a healthy lifestyle and learning procedures to manage their own long-term conditions. Self-management can exist with or without ongoing support from health professionals, depending on the difficulty of the management required.

A large and growing number of patients live with chronic health conditions. Encouraging self-management is a promising means of decreasing use of expensive forms of care such as hospital care, without compromising patient health outcomes.

It is currently unknown which models of self-management support are associated with significant reductions in health services utilization among patients with long-term conditions.

How the review was done

A detailed search of a number of electronic databases for studies published prior to 2012 was conducted. Studies that focused on patients with long-term conditions receiving self-management support, and which measured subsequent patient hospital admission and quality of life, were included in the review.

A total of 12,078 unique studies were identified in searches, and 184 were included in the review after assessments for eligibility.

This review was funded by the Health Services and Delivery Research program, which is part of the National Institute for Health Research (U.K.).

What the researchers found

Self-management support interventions had a small but positive impact on patient quality of life, although a small number of studies reported decreased health outcomes in some patients.

Self-management generally led to small but significant reductions in hospital care use in patients with respiratory and cardiovascular conditions. Use of hospital care was consistently reduced with both lower-intensity self-management interventions and intensive interventions incorporating substantial support from healthcare professionals.

The authors were unable to determine which specific models of self-management were consistently associated with reductions in hospital care, beyond the general finding that interventions in patients with respiratory and cardiovascular conditions were most reliably associated with positive effects.

Conclusion

Self-management support interventions led to small but significant improvements in patient quality of life, and small reductions in hospital admissions for patients with respiratory and cardiovascular conditions. Further research is needed to explore self-management in patients with more than one long-term condition.

This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.