Interventions to Support Behavioral Self-Management of Chronic Diseases

Abstract

A majority of the US adult population has one or more chronic conditions that require medical intervention and long-term self-management. Such conditions are among the 10 leading causes of mortality; an estimated 86% of the nation's $2.7 trillion in annual health care expenditures goes toward their treatment and management. Patient self-management of chronic diseases is increasingly essential to improve health behaviors, health outcomes, and quality of life and, in some cases, has demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic conditions. This review synthesizes the current state of the science of chronic disease self-management interventions and the evidence for their effectiveness, especially when applied with a systematic application of theories or models that account for a wide range of influences on behavior. Our analysis of selected outcomes from randomized controlled trials of chronic disease self-management interventions contained in 10 Cochrane systematic reviews provides additional evidence to demonstrate that self-management can improve quality of life and reduce utilization across several conditions.

Keywords: chronic diseases; disease management; disease self-management; health behavior; health care utilization; health outcomes.

Figure 1

(a) Fixed effects meta-analyses and (b) fixed effects cumulative meta-analyses for self-management (SM) intervention versus a control from the systematic reviews from the Cochrane Airways group in Table 1, which includes the primary outcome health-related quality of life (HRQoL) assessed by St George’s Respiratory Questionnaire (SGRQ). Panel a shows the significant increase in the HRQoL for the SM intervention as compared with usual care. Panel b reveals that this significant increase in the HRQoL for the SM intervention appeared in the literature in 2009 and has remained stable in subsequent years. Data from Reference . Other abbreviations: CI, confidence interval; WMD, weighted mean difference.

Figure 1

(a) Fixed effects meta-analyses and (b) fixed effects cumulative meta-analyses for self-management (SM) intervention versus a control from the systematic reviews from the Cochrane Airways group in Table 1, which includes the primary outcome health-related quality of life (HRQoL) assessed by St George’s Respiratory Questionnaire (SGRQ). Panel a shows the significant increase in the HRQoL for the SM intervention as compared with usual care. Panel b reveals that this significant increase in the HRQoL for the SM intervention appeared in the literature in 2009 and has remained stable in subsequent years. Data from Reference . Other abbreviations: CI, confidence interval; WMD, weighted mean difference.

Figure 2

(a) Random effects meta-analyses and (b) Random effects cumulative meta-analyses for a self-management (SM) intervention versus a control from the systematic reviews from the Cochrane Airways group in Table 1, which includes the primary outcome all-cause hospitalization days. Panel a shows a marginally significant decrease in all-cause hospitalization days for the SM intervention as compared with usual care. Panel b reveals that this marginal significant reduction in the all-cause hospitalization days for the SM intervention appeared in the literature in 2010 and has remained stable in subsequent years. Other abbreviations: CI, confidence interval; WMD, weighted mean difference.

Figure 2

(a) Random effects meta-analyses and (b) Random effects cumulative meta-analyses for a self-management (SM) intervention versus a control from the systematic reviews from the Cochrane Airways group in Table 1, which includes the primary outcome all-cause hospitalization days. Panel a shows a marginally significant decrease in all-cause hospitalization days for the SM intervention as compared with usual care. Panel b reveals that this marginal significant reduction in the all-cause hospitalization days for the SM intervention appeared in the literature in 2010 and has remained stable in subsequent years. Other abbreviations: CI, confidence interval; WMD, weighted mean difference.