Self-management interventions to reduce healthcare utilisation and improve quality of life among patients with asthma: a systematic review and network meta-analysis

Problem

Asthma is one of the most common chronic conditions worldwide. Guidelines for treating asthma recommend the use of self-management interventions. However, it is unclear which self-management models are most effective at reducing healthcare utilisation and improving quality of life (QoL).

Approach

A systematic review and network meta-analysis (NMA) of randomised controlled trials to compare the effects of three different Self-management intervention models (multi-disciplinary case-management, regularly-supported self-management and minimally-supported self-management) and self-monitoring models, against usual care and education. The primary outcomes include healthcare utilisation (i.e. hospitalisation or emergency visit) and QoL. Summary standardised mean differences (SMDs) and 95% credible intervals (95%CrI) were estimated using Bayesian NMA with random-effects. Heterogeneity, inconstancy and publication bias were assessed.

Findings

From 1,178 citations we included 105 trials comprising 27,767 participants. In terms of healthcare utilisation, both multi-disciplinary case-management (SMD=-0.18, 95%CrI: -0.32 to -0.05) and regularly-supported self-management (SMD=-0.30, 95%CrI: -0.46 to -0.15) were significantly better than usual care. For QoL, only regularly-supported self-management (SMD = 0.54, 95% CrI: 0.11 to 0.96) showed a statistically significant increase when compared to usual care. For trials including adolescents/children (aged 5-18 years), only regularly-supported self-management showed statistically significant benefits (healthcare utilisation: SMD=-0.21, 95%CrI: -0.40 to -0.03; QoL: SMD=0.23, 95% CrI: 0.03 to 0.48). Multi-disciplinary case-management (SMD=-0.32, 95%CrI: -0.50 to -0.16) and regularly-supported-self-management (SMD=-0.32, 95%CrI: -0.53, -0.11) were most effective at reducing healthcare utilisation in patients with symptoms of severe asthma at baseline.

Consequences

This is the largest study to use NMA to assess the relative merits of different models of self-management in the treatment of asthma. We conclude that regularly-supported self-management is the most optimal intervention model for improving healthcare utilisation and QoL. Future research and policy investments need to focus on implementing regularly supported self-management, targeting multi-disciplinary case management on those with complex disease.