Supported asthma self-management: A systematic overview from a service perspective

Abstract

Aim: Routine implementation of asthma self-management is a challenge for healthcare services. Our overview synthesised evidence of supported asthma self-management to inform healthcare providers and policy. Key questions were: Does self-management improve health outcomes? Which components and contextual factors impact effectiveness? Is it cost effective? Methods: We combined two parallel programmes of work; both followed Cochrane methodology. The Practical Systematic Review of Self-Management Support (PRISMS) searched for systematic reviews (SRs) plus Randomised Controlled Trials (RCTs) from the last search date of included SRs. Reducing Care Utilisation through Self-management Interventions (RECURSIVE) completed a meta-analysis of RCTs reporting health economic outcomes. Results: PRISMS included 25 SRs and 13 RCTs; RECURSIVE included 26 RCTs. Supported self-management reduces hospitalisations (in 5/11 SRs), A&E visits (in 7/9 SRs), unscheduled consultations (in 6/8 SRs), and improves markers of asthma control (in 5/9 SRs). Core components are patient education, provision of a personal asthma action plan, and support by regular review. Tailoring content and delivery to cultural, clinical and demographic groups is crucial. The cost of providing self-management support is offset by a reduction in hospitalisations and unscheduled healthcare. Conclusion: Supported self-management for asthma is a cost effective intervention that reduces unscheduled care, and improves asthma control. To implement optimal self-management, healthcare providers should take responsibility for providing necessary skills training for clinicians and ensuring the healthcare system values and embeds self-management support.