Abstract
BackgroundSelf-management is an important component of care for patients or consumers (henceforth termed patients) with chronic conditions. Research shows that patients view guidelines as potential sources of self-management support. However, few guidelines provide such support. The primary purpose of this study was to characterize effective types of self-management interventions that could be packaged as resources in (i.e., appendices) or with guidelines (i.e., accompanying products).MethodsWe conducted a meta-review of systematic reviews that evaluated self-management interventions. MEDLINE, EMBASE, and the Cochrane Library were searched from 2005 to 2014 for English language systematic reviews. Data were extracted on study characteristics, intervention (content, delivery, duration, personnel, single or multifaceted), and outcomes. Interventions were characterized by the type of component for different domains (inform, activate, collaborate). Summary statistics were used to report the characteristics, frequency, and impact of the types of self-management components. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the methodological quality of included reviews.ResultsSeventy-seven studies were included (14 low, 44 moderate, 18 high risk of bias). Reviews addressed numerous clinical topics, most frequently diabetes (23, 30 %). Fifty-four focused on single (38 educational, 16 self-directed) and 21 on multifaceted interventions. Support for collaboration with providers was the least frequently used form of self-management. Most conditions featured multiple types of self-management components. The most frequently occurring type of self-management component across all studies was lifestyle advice (72 %), followed by psychological strategies (69 %), and information about the condition (49 %). In most reviews, the intervention both informed and activated patients (57, 76 %). Among the reviews that achieved positive results, 83 % of interventions involved activation alone, 94 % in combination with information, and 95 % in combination with information and collaboration. No trends in the characteristics and impact of self-management by condition were observed.ConclusionsThis study revealed numerous opportunities for enhancing guidelines with resources for both patients and providers to support self-management. This includes single resources that provide information and/or prompt activation. Further research is needed to more firmly establish the statistical association between the characteristics of self-management support and outcomes; and to and optimize the design of self-management resources that are included in or with guidelines, in particular, resources that prompt collaboration with providers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0419-1) contains supplementary material, which is available to authorized users.
Highlights
Self-management is an important component of care for patients or consumers with chronic conditions
Data extracted from eligible systematic reviews describing selfmanagement interventions were thematically analyzed to categorize them according to type of self-management components and assess observable patterns of association between type of self-management components and beneficial outcomes reported by eligible studies
Eligible reviews addressed a wide range of clinical topics that were categorized as metabolic conditions which were all related to diabetes (23, 29.9 %); musculoskeletal conditions such as arthritis and back pain (12, 15.6 %); reviews of a variety of chronic conditions (12, 15.6 %); cardiovascular conditions such as angina, hypertension, heart disease, and stroke (11, 14.3 %); pulmonary conditions such as asthma and chronic obstructive pulmonary disease (7, 9.1 %); other conditions such as cancer pain, irritable bowel syndrome, epilepsy, multiple sclerosis, and kidney disease (7, 9.1 %); and mental illness including anxiety and depression (5, 6.5 %)
Summary
Self-management is an important component of care for patients or consumers ( termed patients) with chronic conditions. Research shows that patients view guidelines as potential sources of self-management support. Governments, professional societies, foundations, academic groups, and other organizations worldwide develop guidelines which translate scientific research findings into recommendations that have the potential to enhance health care quality and outcomes [1]. Interviews with health care professionals revealed that they struggled to interpret and apply guidelines, and that they desired tools that would facilitate guideline implementation [7]. Experts have advocated for the development of guideline-based implementation tools that could be used by patients and providers to clarify the goals of care, understand the underlying evidence, assess the risks and benefits of treatment options, and enable informed decisionmaking [3, 4]. We revealed that few guidelines published between 1980 and 2013 offered information or tools to support implementation [11]. We engaged the international guideline community to produce a framework and considerations with which to assess and adapt existing or develop new guideline implementation tools [15, 16]
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