Self-Management Interventions Reduce Healthcare Use in Asthma Patients

Alexander Hodkinson, PhD

Self-management interventions reduce the use of healthcare resources and improve the quality of life for patients with all levels of asthma severity, according to recent study findings.

The findings emphasized the role of healthcare providers in helping patients with asthma self-manage their condition.

Alexander Hodkinson, PhD, and colleagues searched databases from January 2000 to April 2019 to compare the different self-management and self-monitoring models against usual care and education to determine which most effectively reduced healthcare use and improved quality of life in patients with asthma. The team used terms and text words about self-management interventions and asthma.

Hodkinson and the investigators included studies of patients with asthma between the ages 5-59 years old. Self-management interventions were categorized into 3 types: multidisciplinary case management involving action planning, regularly supported self-management (a total of more than 2 hours of support at regular intervals), and minimally supported self-management (less than 2 hours of consultation during the intervention).

Primary outcomes of the studies included in the analysis were healthcare use like hospital admission and accident and emergency visits, and quality of life. Total cost was a secondary outcome.

After the search and full-text screening, the final analysis included 105 randomized controlled trials comprising 27,767 patients. A majority of the patients (15,693) were randomly assigned to 1 of the 3 self-management interventions: 1365 were compared with self-monitoring, 6640 wish usual care, and 4069 with education.

Among the studies involving adults, the median age was 46 years old while those involving adolescents or children had a median age of 14 years old. The most common intervention model was regularly supported self-management (54 trials), followed by multidisciplinary case management (36 trials).

For hospital use, multidisciplinary case management (standardized mean differences [SMDs], -.18; 95% CI, -.32 to -.05) and regularly supported self-management (SMD, -.3; 95% CI, -.46 to -.15) were significantly better than usual care. In terms of quality of life, regularly supported self-management (SMD, .54; 95% CI, .11-.96) demonstrated a statistically significant benefit over usual care.

In trials including adolescents and children aged 5-18 years old, only regularly supported self-management demonstrated statistically significant benefits (healthcare use: SMD, -.21; 95% CI, -.4 to -.03; quality of life: SMD, .23; 95% CI, .03-.48).

The investigators reported both multidisciplinary case management (SMD, -.32; 95% CI, -.5 to -.16) and regularly supported self-management (SMD, -.32; 95% CI, -.53 to -.11) were the most effective interventions at reducing healthcare use in patients with severe asthma symptoms at baseline.

International guidelines have recommended the use of self-management interventions for patients with asthma to help them undertake management of their condition through education, training, and support. In trials that provided scheduled follow-up of at least 2 hours of contact with a healthcare professional were more effective at reducing healthcare use and improving quality of life than interventions that offered less time.

“Keeping people with asthma connected with their (general practitioners) and healthcare professionals is the best way to improve their wellbeing and prevents avoidable visits to hospitals and emergency departments,” Hodkinson wrote in an accompanying article.

The study, “Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: a systematic review and network meta-analysis,” was published online in BMJ.