Clinical research studyEffectiveness of Chronic Obstructive Pulmonary Disease-Management Programs: Systematic Review and Meta-Analysis
Section snippets
Operational Definition of Disease Management
On the basis of several definitions,7, 10 we decided a priori that studies would meet our operational definition of disease management if their interventions included 2 or more different components (eg, physical exercise, self-management, structured follow-up), 2 or more health care professionals were actively involved in patient care, patient education was considered, and at least 1 component of the intervention lasted a minimum of 12 months. The latter criterion was set to avoid selecting
Results
The systematic search identified 12,749 titles that resulted in 1155 articles further screened by abstract, leading to 139 that were fully reviewed. Thirteen studies (15 articles) were retained (Figure 1)20, 28, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 and are described in Table 1 (available online). Nine were randomized controlled trials, 1 was a nonrandomized controlled trial, and 3 were uncontrolled before–after trials. The interventions varied in terms of their components and
Discussion
Our systematic review suggests that COPD disease-management programs improve exercise capacity, reduce the risk of hospitalization, and moderately improve health-related quality of life. Effects on lung function tests and symptoms were modest and probably not clinically relevant in isolation, and the point estimate of all-cause mortality tended to favor the intervention groups, but the CI remained too large to allow any definitive conclusion.
This review extends the work of other authors who
Conclusions
Our comprehensive systematic review of the literature suggests that disease-management programs for patients with COPD slightly improve exercise capacity and quality of life, and reduce hospitalization. Given the limits of classic pharmacotherapy alone at improving outcomes in COPD, the increase in walking distances and reduction of hospitalization induced by disease management are notable findings, and the nonsignificant lower all-cause mortality is a promising result. On the basis of our
Acknowledgments
The authors thank Anne Parrical and Anne Pittet, medical librarians at the University of Lausanne, and Drs Poole, Rea, Ries, and Soler-Cataluña, for providing further details on their studies.
References (48)
- et al.
Chronic obstructive pulmonary disease
Lancet
(2003) - et al.
Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study
Lancet
(1997) - et al.
The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes
Chest
(2006) - et al.
Does disease management improve clinical and economic outcomes in patients with chronic diseases?A systematic review
Am J Med
(2004) - et al.
A systematic review of randomized trials of disease management programs in heart failure
Am J Med
(2001) - et al.
The effectiveness of disease and case management for people with diabetesA systematic review
Am J Prev Med
(2002) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
The Health Technology Assessment-disease management instrument reliably measured methodologic quality of health technology assessments of disease management
J Clin Epidemiol
(2004) - et al.
Long-term effects of outpatient rehabilitation of COPD: a randomized trial
Chest
(2000) - et al.
Effectiveness of a specific program for patients with chronic obstructive pulmonary disease and frequent exacerbations
Arch Bronconeumol
(2006)
Global burden of COPD: systematic review and meta-analysis
Eur Respir J
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
Eur Respir J
Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease
Ann Intern Med
Improving quality of care through disease management: principles and recommendations from the American Heart Association's Expert Panel on Disease Management
Circulation
Disease management: definitions, difficulties and future directions
Bull World Health Organ
Evidence-based disease management
JAMA
DMAA definition of disease management
Disease managementA new technology in need of critical assessment
Int J Technol Assess Health Care
The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports
Eur Heart J
Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patientsA meta-analysis
Eur J Heart Fail
Effectiveness of disease management programs in depression: a systematic review
Am J Psychiatry
Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials
Med Care
A systematic review of diabetes disease management programs
Am J Manag Care
A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease
Intern Med J
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Dr Isabelle Peytremann-Bridevaux is supported by a grant from the Bourse de la commission pour la promotion académique des femmes, faculté de biologie et médecine de l'université de Lausanne.