Author (year); country | Study types, n; participants n; databases | Condition(s); population(s); review type | Comparator; QA score; time scale | Intervention summary; health/social care settings | Findings of review by outcome (intervention vs control) |
---|---|---|---|---|---|
Case management | |||||
Hickam et al (2013);23 USA | RCTs, observational n=153 Not specified 5 databases, inception—2011 | Chronic disease Adult patients with complex care needs Narrative | Care without a case management component 4 6–36 months | Intensive interventions: multiple face-to-face interactions, home visits vs less intensive interventions: infrequent contact Delivered by case managers working alone or within a MDT of health professionals. Primary, secondary, community | Admissions: 2 studies found case management to be more effective in patients with greater disease burden. A further 4 studies found case management to be effective when case managers have greater levels of personal contact with patients (low quality evidence). Costs (4 studies): 3 found no difference between groups. One study found higher overall costs in intervention group vs control. |
Hutt et al (2004);24 UK | RCTs, CCTs, before/after n=20 n=18 002 ‘Major’ databases, 1996–2004 | Chronic disease Over 65s with any chronic condition (mental health excluded) Narrative | Care without a case management component 3 At least 3 months | Home visits and/or periodic reassessment, ranging from case manager assessment at hospital or home with occasional telephone contact, to regular intensive contact where case managers arranged medical appointments and were contactable 24/7. Delivered by case manager (nurse or social worker). Primary, secondary, community. | Admissions (18 studies): 5 showed a significant reduction in admissions in intervention groups; 7 found no difference between groups; 4 found non-significant reductions, 2 found non-significant increases in admissions in the intervention group LoS (16 studies): 3/16 showed significant decrease, 2/16 showed non-significant increase, 11/16 showed no differences. A&E use (8 studies): 3 showed significant reduction, 2 showed significant increases, 2 showed non-significant increases. Costs (10 studies): 4 showed non-significant increases in intervention; 6 reported reductions although only 1 was significant. |
Latour et al (2007);25 Netherlands | RCTs, CCTs, before/after n=10 n=5092 4 databases, inception-2005 | Chronic disease Adult patients with acute or chronic conditions Narrative | Care without a case management component 3 3–18 months | Postdischarge nurse-led case management for complex patients, delivered in the outpatient setting. Needs assessment, service plans, monitoring, assessment, evaluation, follow-up via home visits and/or telephone. Secondary, community | Readmissions (9 studies): 3 high quality, 1 low quality reported positive results for intervention. 4 studies (2 high quality) showed no difference between groups; 1 presented insufficient data. LoS (6 studies): 2 showed significant reduction, 2 showed non-significant reduction, 2 showed no difference between groups. A&E use (4 studies): Strong evidence that intervention had no significant impact. |
Manderson et al (2012);26 Canada | RCTs n=15 n=2317 5 databases, 1999–2011 | Chronic disease Older people Narrative | Not specified 3 1–18 months | Care planning and coordination via phone support, home visits, liaison with medical and community services and/or education. APN, care coordinators, case managers. Primary, secondary, community | Costs (9 studies): 5 reported positive economic outcomes, 4 did not. Specific data and effect sizes not given. |
Oeseburg et al (2009);27 Netherlands | RCTs n=9 n=15 746 3 databases, 1995–2007 | Chronic disease Community dwelling patients Narrative | Care without a case management component 3 10–36 months | Home visits and/or telephone calls. Delivered by a case manager (nurse, social worker or nurse practitioner) who was either a member of a MDT or acted independently. Primary, secondary, community | Admissions (6 studies): 1 showed small reduction in favour of intervention (good quality). One found small increase in intervention group (weak quality). LoS (5 studies): One reported small reduction in days per year in hospital in intervention group. A&E use (5 studies): One reported small reduction in intervention, 1 reported an increase. 3 reported no difference. Costs (3 studies): 1 reported significant but trivial saving in intervention. Another found 19% cost reduction due to savings in nursing home, hospital and community costs. A third found costs to be higher in intervention (non-significant). |
Stokes et al (2015);43 UK | RCTs, CCTs, before/after, time series n=36 n=23 711 6 databases, inception-2014 | Chronic disease Adult patients with chronic diseases SR and meta-analysis | Care without a case management component 4 6–60 months | Community-based MDTs responsible for delivering and coordinating services; MDT care plan following case worker assessment, case manager constantly available to deal with problems. Delivered by care manager, nurse, pharmacist, GP collaborating with nurse. Primary, community | Costs: No significant effects found: Short term (0–12 months): SMD −0.00 CI −0/07 to 0.06 Longer term (13+ months): SMD −0.03 CI −0.16 to 0.10 |
Taylor et al (2005);44 UK | RCTs n=9 n=1428 24 databases, 1980–2005 | COPD Patients with COPD in the community SR and meta-analysis | Conventional postdischarge care 4.5 3–12 months | Brief (1 month) or longer term (12 months) inpatient, outpatient or community-based interventions. All were led, coordinated or delivered by respiratory nurses via home visits, with or without telephone follow-up. Primary, secondary, community | Readmissions: Equivocal evidence for reduction in all-cause readmission at 12 months. One study found a 40% reduction in readmission for acute exacerbation and 57% reduction in all-cause readmission. Another found a significant reduction in readmissions. Three further studies found no effect. |
Thomas et al (2013);45 UK | RCTs n=10 Not specified 18 databases, inception-2010 | Heart failure Adult patients SR and meta-analysis | Not specified 3 3–18 months | Specialist HF management education:
| Admissions:
|
Chronic care model | |||||
Adams et al (2007);46 USA | RCTs n=32 Not specified 3 databases, inception-2005 | COPD Adult patients with COPD SR and meta-analysis | Not specified 4 6 weeks to 24 months | At least one component of Wagner's CCM. Categorised according to the number of components an intervention included. Primary, secondary, community | Admissions: No difference in rates for interventions with 1 CCM component (n=7). Significant reduction for interventions with multiple CCM components (n=4); RR 0.78, 95% CI 0.66 to 0.94). LoS:
|
de Bruin et al (2012);28 Netherlands | RCTs, CCTs, before/after, case–control n=41 n=78 590 6 databases, 1995–2011 | Chronic disease Adult patients with multiple chronic conditions Narrative | Not specified 4.5 Not specified | Studies categorised by number of CCM components they included. Multiple settings, from home care organisations and community centres to primary care, hospitals, specialist clinics. Some included newly established partnerships; others provided regular care in settings where it was not normally given. Primary, secondary, community | Admissions: 3/16 studies found significantly reduced admissions. Costs (5 studies): All reported negative incremental direct healthcare costs for patients receiving intervention. Costs ranged from −US$5708 to −US$204 per patient per year, primarily due to lower inpatient costs in the intervention group. |
Gonseth et al (2004);47 Spain | RCTs, CCTs, n=27 Not specified 3 databases, inception-2003 | Heart failure Over 65s with principle or secondary diagnosis of HF SR and meta-analysis | Care without a CCM component 4.5 3–48 months | Education, counselling, diet advice, self-care support, discharge planning, focus on hospital to home transition, medication management, clinic review, GP follow-up. Most delivered by nurses. Varied timing (eg, in-hospital or postdischarge), organisation (eg, home care or outpatient clinic visit), duration (from single home visit to intensive intervention lasting 12 months). Primary, secondary, community | Readmissions: Reduced regardless of follow-up length or whether intervention delivered at home or in clinic setting. All-cause (6 studies): 15% reduction in readmissions (RR 0.85, 95% CI 0.79 to 0.92). HF-specific (6 studies): 30% reduction in readmissions (RR 0.70, 95% CI 0.62 to 0.79). Costs (11 studies): 10 estimated the intervention reduced costs. One reported similar costs in intervention and usual care groups. |
Hisashige (2013);69 Japan | SR and meta-analyses n=28 Not specified 9 databases, 1995–2010 | Chronic disease Adult patients Review of reviews | Not specified 3.5 Not specified | All interventions had 1+ CCM component. Typically multidisciplinary approaches with clinical follow-up by specialists, home visits, hospital discharge planning or postdischarge follow-up, counselling in hospital and patient education or reminders. Primary, secondary, community | Admissions (22 studies): ‘Improvement with a reasonable amount of evidence’ with intervention seen in 63% of studies (14/22). Costs (16 studies): 6/16 (38%) observed ‘improvement in costs with a reasonable amount of evidence’. Costs tended to focus on healthcare costs and typically did not include estimates of intervention costs. |
Kruis et al (2013);48 Netherlands | RCTs n=26 n=2997 5 databases, 1990-present | COPD Adult patients with clinical diagnosis of COPD SR and meta-analysis | Regular follow-up visits to healthcare providers 5 3–24 months | Multidisciplinary (2+ providers), multitreatment (2+ CCM components), 3+ months duration. Categorised as:
| Admissions: All-cause: number of participants with one or more admissions over 3–12 months was 27 per 100 in control vs 20 per 100 in intervention (OR 0.68, 95% CI 0.47 to 0.99, p=0.04). Respiratory related: at 3 months (7 studies), significant reduction (0.68, 95% CI 0.47 to 0.99, p=0.04). At 12 months (1 study), no difference observed. LoS: Significantly lower in the intervention group. Mean difference −3.78 days (95% CI −5.90 to −1.67, p<0.001). |
Lemmens et al (2009);49 Netherlands | RCTs, before/after n=36 Not specified 2 databases, 1995–2008 | COPD Adult patients with asthma or COPD SR and meta-analysis | Care with 0 or 1 CCM components 5 6 weeks to 24 months |
| Readmissions:
|
Peytremann-Bridevaux et al (2008);50 Switzerland | RCTs, controlled before/after n=13 n=8179 5 databases, inception-2006 | COPD Adult patients undergoing disease management SR and meta-analysis | Care without a CCM component 4 12 months | All included 2+ CCM components; at least 1 component must have lasted 12 months. Delivered by 2+ health professionals, eg, respiratory nurse, physiotherapist, GP, practice nurse, social worker, case manager, pulmonary care physician. Primary, secondary, community | Admissions (10 studies): 7 showed significant effects in favour of intervention; 3 found no reduction in admissions. |
Steuten et al (2009);29 Netherlands | Any with data at two time points n=20 Not specified 2 databases, 2005–2007 | COPD Mild, moderate, severe or very severe COPD Narrative | Care without a CCM component 3.5 2–24 months | All included 2+ CCM components. All included self-management and delivery system redesign. Several programmes additionally encompassed decision support and/or clinical information systems Primary, secondary, community | Readmissions: 8/15 studies reported a reduction in readmission rates (3 statistically significant). Relative risk of readmission ranged from 0.64 to 1.50. Statistically significant improvements all seen in studies with 3 or 4 intervention components. Studies with fewer components showed no significant reductions. Costs (3 studies): Differences found in individual domains, eg, higher prescription costs, lower hospital costs, reduced sick leave costs. No studies reported statistically significant findings. |
Woltmann et al (2012);51 USA | RCTs n=78 Not specified 6 databases, inception-2011 | Mental health Adult patients with mental health problems SR and meta-analysis | Not specified 5 3–36 months | Eligible interventions had to have at least 3 CCM components. Primary, secondary, community | Costs (21 studies): 10 reported p values. 9 of these reported no difference between intervention and control groups; 1 favoured control condition. No statistically significant findings in any study. |
Discharge management | |||||
Bettger et al (2012);30 USA | RCTs, observational, n=44 Not specified 4 databases, 2000–2012 | Stroke, Cardiac Patients hospitalised for stroke/MI Narrative | Not specified 4 Not specified |
Secondary, community | Readmissions:
|
Brady et al (2005);31 Canada | Cost analyses, economic evaluations n=15 n=6201 6 databases, 1995–2002 | Stroke Adult patients with clinical definition of stroke Narrative | Standard hospital discharge and rehabilitation 4 Up to 12 months |
| Costs:
|
Fearon et al (2012);52 UK | RCTs n=14 n=1957 Multiple databases to 2012 | Stroke Adult patients admitted to hospital with stroke SR and meta-analysis | Standard discharge arrangements 5 3–12 months |
| Readmissions (7 studies): readmission rates similar in intervention to usual care (31% vs 28%). LoS (13 studies): Pooled results showed significant reduction (p<0.0001). Reduction more marked in hospital outreach group than community inreach group but not statistically significant (p=0.24). Costs (7 studies): Overall, costs ranged from 23% less for ESD group to 15% more compared to control. No subgroup cost analyses possible. |
Feltner et al (2014);53 USA | RCTs n=47 Not specified 5 databases, 2007–2013 | Heart failure Adult patients with moderate to severe HF SR and meta-analysis | Standard discharge arrangements 4 3–6 months | At least one of:
| Readmissions:
|
Jeppesen et al (2012);54 Norway, UK, Australia | RCTs n=8 n=870 7 databases, inception-2010 1 inception-2012 | COPD Adult COPD patients in ED with acute exacerbation SR and meta-analysis | Standard discharge arrangements 4.5 6 months | Hospital at home: regular home visits by a trained respiratory nurse supported by the hospital team and telephone support. Secondary, community | Readmissions (8 studies): Significant reduction in intervention group. 9 fewer readmissions per 100 compared to inpatient care (RR 0.76, 95% CI 0.59 to 0.99, p=0.04). Costs (3 studies): 2 reported significant reduction in direct costs for intervention; 1 reported non-significant reduction. Authors stress low quality of economic evidence. |
Lambrinou et al (2012);55 Greece | RCTs n=19 Not specified 3 databases, 2001–2009 | Heart failure Adult patients with HF SR and meta-analysis | Standard discharge arrangements 4 3–35 months | Nurse-driven predischarge phase, incorporating discharge planning or inpatient education and/or evaluation. Telephone follow-up; HF clinic follow-up; home follow-up or a combination. Secondary, community | Readmissions:
|
Langhorne et al (2005);56 UK | RCTs n=11 n=1597 Databases not specified | Stroke Inpatients with clinical diagnosis of stroke SR and meta-analysis | Standard hospital discharge and rehabilitation 5 3–12 months |
Secondary, community | Readmissions (5 studies): similar rates between intervention and control (27% vs 25%; OR 1.14, 95% CI 0.80 to 1.63). LoS (9 studies): Overall, significant reduction in intervention of 7.7 days (95% CI 4.2 to 10.7). Reduction greater for hospital outreach than community inreach (15 days, 95% CI 9 to 22 vs 5 days, 95% CI 1 to 9). Controlling for stroke severity, greater reduction in severe vs moderate group (28 days, 95% CI 15 to 41 vs 4, 95% CI 2 to 6). Costs (5 studies): Intervention costs lower than control (range 4% to 30% lower; median reduction 20%). Significance not stated. |
McMartin (2013);57 Canada | RCTs, SR, meta-analysis n=11 Not specified 6 databases, 2004–2011 | Chronic disease Adults with chronic diseases SR and meta-analysis | Standard discharge arrangements 3 Not specified |
| Readmissions:
|
Olson et al (2011);32 USA | RCTs, observational, registries n=62 Not specified 4 databases, 2001–2011 | Stroke, cardiac Adults discharged after acute stroke or MI Narrative | No transitional care across multiple providers 3.5 12 months |
Secondary, community | Readmissions:
|
Phillips et al (2004);58 USA | RCTs n=19 Not specified 7 databases, inception-2003 | Heart failure Older patients with congestive heart failure SR and meta-analysis | Standard discharge arrangements 5 3–12 months | Postdischarge support as:
| Readmissions:
Costs (8 studies): 4 US based studies found significant costs reductions per patient per month of US$536 (95% CI −US$956 to −US$115). 4 non-US studies found no significant cost differences. |
Phillips et al (2005);59 USA | RCTs n=7 n=949 5 databases, inception-2004 | Heart failure Adult patients with heart failure SR and meta-analysis | Not specified 4 3–12 months | Specialist nurse-led clinics to manage discharge transitions. Categorised by:
| Readmissions:
Costs: Only reported for complex interventions. 3 studies showed non-significant potential savings of US$277 per patient per month. |
Prieto-Centurion (2014);33 USA | RCTs n=5 n=1393 4 databases, inception-2013 | COPD Exacerbation in previous 12 months Narrative | Not specified 3 6 or 12 months | Predischarge, postdischarge or bridging interventions across both periods. Education, health counselling, action plans delivered via telephone, home visits or consultation with primary care providers Primary, secondary, community | Readmissions:
|
Tummers et al (2012);34 Netherlands | RCTs, CCTs, n=15 n=3536 2 databases, inception-2011 | Stroke Adult patients who had stroke Narrative | Standard hospital discharge and rehabilitation 3 3–12 months | Interventions grouped according to:
| Costs:
|
Winkel et al (2008);35 Denmark, Sweden | RCTs n=17 n=1122 5 databases, inception-2005 | Stroke Adult patients who had been living at home before a stroke Narrative | Standard discharge arrangements 4 1–12 months | Delivered by MDTs which all included physiotherapists and OTs. Some also included nurse, social worker, GP and other specialist expertise, eg, geriatrician.
| Readmissions:
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Yu et al (2006);36 Hong Kong | RCTs n=21 n=4445 3 databases, 1995–2005 | Heart Failure Adult patients with heart failure Narrative | Not specified 4 3–50 months | Postdischarge interventions delivered via home visits, HF clinic visits and/or telephone. Interventions comprised multidisciplinary care, case management and structured discharge planning and all included patient education and/or self-management Primary, secondary, community | Readmissions: 11 ‘effective’ programmes had significant reductions ranging from 29% to 85%. 10 others demonstrated no significant changes. Effective programmes included an in-hospital phase, patient education, self-care, surveillance and deterioration management. Involvement of cardiac nurses and cardiologists associated with increased likelihood of successful intervention. Costs: 8 ‘effective’ programmes did cost analysis, 7 of which showed a cost saving for the intervention over usual care. |
Complex interventions | |||||
Dickens et al (2014);60 UK | RCTs n=32 n=3941 5 databases, inception-2013 | COPD Adult patients with COPD SR and meta-analysis | Not specified 4 1–24 months | Multiple components and/or multiple professionals, given individually or in groups, or using technology. Could include education, rehabilitation, psychological therapy, social or organisational interventions. Delivered at home, in community, hospital or doctor clinic or combination of these. Primary, secondary, community | A&E use: Pooled effects showed interventions associated with 32% reduction (OR 0.68, 95% CI 0.57 to 0.80). Subgroups: General education (28 studies): OR 0.66, 95% CI 0.55 to 0.81. Exercise (11 studies): OR 0.60, 95% CI 0.48 to 0.76. Relaxation (4 studies): OR 0.48, 95% CI 0.33 to 0.70. Non-significant trends for interventions including skills training (p=0.35, 13 studies), relapse prevention (p=0.12, 11 studies). |
Martinez-González et al (2014);70 Switzerland | SR, meta-analyses n=27 Not specified 4 databases, inception-2012 | Chronic disease Adult patients with chronic diseases Review of reviews | Not specified 3 Not specified | Included any interventions based on disease management, case management, managed care, comprehensive care, multidisciplinary care, coordinated care, team care, CCMs. Primary, secondary, community | Admissions: 10/17 reviews demonstrated reduced admissions Readmissions: 7/12 reviews demonstrated reduced readmissions LoS: 9/13 reviews demonstrated shorter length of stay A&E use: 6/11 reviews showed reduced rates of ED visits Costs: 3/17 reviews demonstrated cost reductions |
Takeda et al (2012);61 UK | RCTs n=25 n=5942 10 databases, inception to 2009 | Heart failure Adults with at least one HF secondary care admission SR and meta-analysis | Not specified 5 6–24 months | All led by professionals from secondary or tertiary care. Interventions grouped as:
| Readmissions:
|
Multidisciplinary teams | |||||
Health Quality Ontario (2012);71 Canada | SR and meta-analyses n=24 Not specified 6 databases, 2008–2011 | Heart failure, COPD Adult patients with heart failure or COPD Review of reviews | Usual care in general practice 3 Not specified | Interventions to provide formalised links between primary and specialist care via disease-specific education, medication review, physical activity and lifestyle counselling, self-care and follow-up. Delivered by intermediate care teams including GPs, specialists, nurses, social workers, pharmacists, dieticians. Primary, secondary, community | Admissions:
|
Health Quality Ontario (2013);37 Canada | SR, RCTs, observational studies n=20 Not specified 5 databases, 2002–2011 | Chronic disease Adult patients with one or more chronic diseases Narrative | Not specified 3 Not specified | Informational, management and relational continuity. Assessed by:
| Admissions:
|
Holland et al (2005);62 UK | RCTs n=30 n=815813 databases inception-2004 | Heart failure Adult patients with congestive heart failure SR and meta-analysis | Not specified 5 Not specified | Interventions with management by an MDT that included medical input plus one or more of specialist nurse, pharmacist, health educator, dietician or social worker:
| Admissions:
Home-based interventions reduced mean days in hospital. Interventions solely delivered in hospital, clinic or primary care showed no significant benefits. |
Koshman et al (2008);63 Canada | RCTs n=12 n=2060 10 databases inception-2007 | Heart failure Adult patients with heart failure SR and meta-analysis | Heart failure care without pharmacist involvement 4 6–12 months | Pharmacists providing HF and medication education through self-monitoring support, compliance facilitation. Either via directed care where pharmacist is the key driver, or collaborative care with pharmacist as part of MDT. Secondary, community | Admissions:
|
McAlister (2004);64 UK | RCTs n=29 n=5039 7 databases, inception-2003 | Heart failure Adult patients with HFSR and meta-analysis | Not specified 4 1–12 months |
| Admissions:
|
Medical Advisory Secretariat (2009);65 Canada | RCTs n=8 n=2692 4 databases, inception-2008 | Heart failure Adult patients with HF SR and meta-analysis | Care not provided by multiple practitioners 4 At least 12 months | All included a team of nurse and physician and/or general practitioner, one of which specialised in HF management. Varying combinations of disease-specific education, diet, lifestyle, exercise counselling, self-care support, follow-up. Delivered directly (clinic based programme) or indirectly (telephone based, physician supervised, nurse-led). Primary, secondary, community | Readmissions:
|
Roccaforte et al (2005);66 Canada | RCTs n=33 Not specified 4 databases, 1980–2004 | Heart failure HF patients followed up in outpatient setting SR and meta-analysis | Referral to family physician or home care services after discharge 5 3–22 months |
| Readmissions:
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Sikich (2012);38 Canada | HTAs, SR, RCTs, n=6 n=1370 6 databases, 1995–2010 | COPD Adult patients with COPD Narrative | Care not provided by multiple practitioners 4 3–12 months | Interventions based on CCM components, delivered by various professionals as a team in one organisation or range of organisations together as a unique team. Most teams included a respiratory specialist and/or a physician. Primary, secondary, community | Admissions:
|
Smith et al (2007);39 Ireland | RCTs, CCTs, before/after, time series n=20 Not specified 7 databases, inception-2006 | Chronic disease Patients in a primary and secondary shared care service Narrative | Care not provided by multiple practitioners 5 Not specified | Liaison meetings attended by specialists and primary care staff to discuss and plan ongoing patient management; shared care record carried by the patient, computer-assisted shared care and email with data available to primary and secondary care Primary, secondary | Admissions (7 studies): Mixed results. Intervention was associated with a reduction in admissions in older patients and those with higher baseline morbidity. Costs (11 studies): 3 performed full economic analyses, of which 2 reported incremental cost savings in intervention. Seven studies reported direct costs: 1 showed higher costs in intervention; 6 reported mixed results (4/6 showed intervention more expensive than control, 2/6 reported lower costs in intervention). |
Smith et al (2012);40 Ireland* | RCTs, CCTs, before/after, time series n=10 n=3357 9 databases, various–2011 | Chronic disease Patients with multimorbidity in primary care or community Narrative | Not specified 5 2–24 months | Any intervention to improve outcomes for patients with multimorbidity in primary or community care delivered by an MDT. 6 studies assessed MDT interventions. Primary, community | Admissions (5 studies): One study found significant reduction in admissions with intervention; 4 found no difference between groups. Costs (4 studies): One reported no difference between groups; one had no results available; one reported a non-significant marginal benefit for intervention, one reported net savings in intervention costs but did not account for other costs. |
Self-management | |||||
Franek (2013);41 Canada | SR, RCTs, meta-analyses n=10 n=6074 5 databases, 2000–2012 | Chronic disease Adult patients with chronic disease Narrative | Care from the usual provider 3.5 4–12 months | Stanford chronic disease programme: 6 weekly 2.5 hour sessions with 10–15 participants, in community settings, with volunteer lay facilitators assisting patients to make their own management choices and reach self-selected goals. Primary, secondary, community | Admissions (3 studies): No significant difference in admission rates between intervention and control in any study (low quality evidence). LoS (5 studies): None showed any significant differences between groups at 6 months. A&E use (5 studies): No significant differences between groups. |
Harrison et al (2015);67 Canada | RCTs n=7 n=1115 7 databases, inception-2014 | COPD Adult patients hospitalised following acute exacerbation SR and meta-analysis | Not specified 3.5 2 weeks-12 months | Action plans involving symptom monitoring, education and at least 2 of 7 self-management skills (self-efficacy, problem solving, resource use, collaboration, emotional/role management, goal setting). Delivered by nurses when patient is in hospital, or within 1 month of discharge. Secondary, community | Readmissions (5 studies). Meta-analysis found no significant differences at 12 months between intervention and control groups in terms of the number of patients readmitted to hospital. Mean difference 1.32, CI 0.71 to 2.46 (p=0.38). |
Jovicic et al (2006);42 Canada | RCTs n=6 n=857 6 databases, inception-2005 | Heart failure Adult patients with HF Narrative | Not specified 4 3–12 months | Education and limited follow-up: patients taught to monitor condition and recognise symptom exacerbation; follow-up phone call and face to face or digital education. Delivered by nurses or AHPs. Secondary, community | Readmissions:
|
Smith et al (2012);40 Ireland | RCTs, CCTs, before/after, time series n=10 n=3357 9 databases, various–2011 | Chronic disease Patients with multimorbidity in primary care or community Narrative | Not specified 5 2–24 months | Any patient-orientated intervention to promote self-management in patients with multimorbidity in primary or community care. Four studies assessed self-management interventions. Primary, community | Admissions (2 studies): One reported significant reduction in favour of intervention. The other found no difference between groups. Costs (2 studies): One reported cost savings per participant due to reduction in admission rates in intervention group. The other found no difference between groups. |
Zwerink et al (2014);68 Netherlands | RCTs, controlled trials, n=31 n=3688 6 databases, 1995–2011 | COPD Patients with clinical diagnosis of COPD SR and meta-analysis | Not specified 5 2–24 months | Structured interventions to improve self-health and self-management skills. At least 2 of action plan, exercise programme, smoking cessation, dietary advice, medication review, coping with breathlessness advice, CBT, motivational interviewing, goal setting, feedback. Primary, secondary, community | Admissions:
|
*Smith et al40 listed twice due to focus on MDT interventions and self-management interventions.
AHP, allied health professional; CBT, cognitive–behavioural therapy; CCM, chronic care model; CCT, controlled clinical trial; ED, emergency department; ESD, early supported discharge; HF, heart failure; HTA, health technology assessment; LoS, length of stay; MDT, multidisciplinary team; MI, myocardial infarction; OT, occupational therapy; QA, quality assessment; RR, relative risk; SMD, standardised mean difference; SR, systematic review.