Systematic review of the effectiveness of community-based self-management interventions among primary care COPD patients

K Jolly,S Majothi,M S Sidhu,R E Jordan,H J Samuel Kim,E Bates,A Sitch,S Bayliss

doi:10.1038/s41533-018-0111-9

Abstract

COPD self-management reduces hospital admissions and improves health-related quality of life (HRQoL). However, whilst most patients are managed in primary care, the majority of self-management trials have recruited participants with more severe disease from secondary care. We report the findings of a systematic review of the effectiveness of community-based self-management interventions in primary care patients with COPD. We systematically searched eleven electronic databases and identified 12 eligible randomised controlled trials with seven included in meta-analyses for HRQoL, anxiety and depression. We report no difference in HRQoL at final follow-up (St George’s Respiratory Questionnaire total score −0.29; 95%CI −2.09, 1.51; I2 0%), nor any difference in anxiety or depression. In conclusion, supported self-management interventions delivered in the community to patients from primary care do not appear to be effective. Further research is recommended to identify effective self-management interventions suitable for primary care populations, particularly those with milder disease.

Highlights

COPD is a significant cause of morbidity and mortality; it accounts for a high consultation rate in general practice[1] as well as significant hospital admission rates for exacerbations which drive the high cost of treatment.[2]
Most participants within self-management trials have been recruited from secondary care with more severe disease than is representative of the population of patients with COPD seen in general practice.[4,5]
In contrast to studies among more severe COPD patients, community-based interventions to support self-management for COPD in primary care were not found to be effective in meta-analyses overall in improving health-related quality of life or in reducing anxiety and depression

Summary

Introduction

COPD is a significant cause of morbidity and mortality; it accounts for a high consultation rate in general practice[1] as well as significant hospital admission rates for exacerbations which drive the high cost of treatment.[2]. Deficiencies in self-management support have been identified in patients attending UK primary care with suboptimal rates of patients having a self-management plan, having received advice on diet or exercise or practical help to stop smoking in the previous year.[6] Interventions to support self-management are heterogeneous and there is a lack of evidence as to whether effective interventions can be implemented and delivered in primary care settings. This is of increasing importance with calls to intervene to reduce risk in people with early stage COPD.[7]

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Results

Conclusion