Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis
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Published version
Author(s)
Smalley, Katelyn
Aufegger, lisa
Flott, kelsey
Mayer, Erik
Darzi, Ara
Type
Journal Article
Abstract
Objective
The study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.
Methods
A systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).
Results
A total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.
Conclusion
This review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.
Practice implications
Practices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.
The study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.
Methods
A systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).
Results
A total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.
Conclusion
This review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.
Practice implications
Practices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.
Date Issued
2021-01
Date Acceptance
2020-08-31
Citation
Patient Education and Counseling, 2021, 104 (1), pp.50-63
ISSN
0738-3991
Publisher
Elsevier
Start Page
50
End Page
63
Journal / Book Title
Patient Education and Counseling
Volume
104
Issue
1
Copyright Statement
© 2020 The Authors. Published by Elsevier B.V. This is an open access article under a CC-BY licence (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
National Institute of Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Identifier
https://www.sciencedirect.com/science/article/pii/S0738399120304420?via%3Dihub
Grant Number
RDB04
n/a
RDPSC 79560
RDPSC 79560
Subjects
Attitudes
Behaviour change
COPD
Chronic disease
Complex interventions
Disease management
Effectiveness
Health behaviour
Health knowledge
Health literacy
Health promotion
Patient education
Patient participation
Practice
Risk reduction behaviour
Self-management
Public Health
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Publication Status
Published
Date Publish Online
2020-09-02