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Meta-Analysis
. 2015 May 27;2015(5):CD007988.
doi: 10.1002/14651858.CD007988.pub2.

Chronic disease management programmes for adults with asthma

Isabelle Peytremann-Bridevaux  1 , Chantal Arditi, Grégoire Gex, Pierre-Olivier Bridevaux, Bernard Burnand
Affiliations
Meta-Analysis

Chronic disease management programmes for adults with asthma

Isabelle Peytremann-Bridevaux et al. Cochrane Database Syst Rev. .

Abstract

Background: The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education.

Objectives: To evaluate the effectiveness of chronic disease management programmes for adults with asthma.

Search methods: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews.

Selection criteria: We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months.

Data collection and analysis: After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs).

Main results: A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes.

Authors' conclusions: There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation.

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Conflict of interest statement

No potential conflict of interest.

Figures

1
1
Flow diagram.
2
2
Description of intervention components by study.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
5
5
Forest plot of comparison: 1 Chronic disease management programme versus usual care, outcome: 1.1 Asthma‐specific quality of life score (post‐intervention measurements).
6
6
Forest plot of comparison: 1 Chronic disease management programme versus usual care, outcome: 1.7 Self‐efficacy score (post‐intervention measurements).
7
7
Forest plot of comparison: 1 Chronic disease management programme versus usual care, outcome: 1.8 Asthma severity score (post‐intervention measurements).
1.1
1.1. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 1 Asthma‐specific quality of life score (post intervention measurements).
1.2
1.2. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 2 Subgroup analysis asthma‐specific quality of life score according to the comprehensiveness of the intervention (≥ 8 / < 8 components).
1.3
1.3. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 3 Subgroup analysis asthma‐specific quality of life score according to the dominant component of the intervention.
1.4
1.4. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 4 Subgroup analysis asthma‐specific quality of life score according to the presence of limited CDM components in the control group.
1.5
1.5. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 5 Subgroup analysis asthma‐specific quality of life score according to QOL scale.
1.6
1.6. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 6 Sensitivity analysis asthma‐specific quality of life (change from baseline measurements).
1.7
1.7. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 7 Self‐efficacy score (post intervention measurements).
1.8
1.8. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 8 Asthma severity score (post intervention measurements).
1.9
1.9. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 9 Lung function (FEV1 and PEF) (post intervention measurements).
1.10
1.10. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 10 FEV1 (% predicted) (post intervention measurements).
1.11
1.11. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 11 PEF (L/min) (post intervention measurements).
1.12
1.12. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 12 PEF (% predicted) (post intervention measurements).
1.13
1.13. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 13 Subgroup analysis lung function according to the comprehensiveness of the intervention (≥ 8 / < 8 components).
1.14
1.14. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 14 Subgroup analysis lung function according to the dominant component of the intervention.
1.15
1.15. Analysis
Comparison 1 Chronic disease management programme versus usual care, Outcome 15 Subgroup analysis lung function according to the presence of limited CDM components in the control group.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to ongoing studies

Ahmed 2011 {published data only}
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