Chronic disease management programmes for adults with asthma

摘要: Background The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set coherent interventions that centre the patients' needs, encouraging co-ordination integration health services provided by variety professionals, emphasising self-management as well education. Objectives To evaluate effectiveness programmes for adults with asthma. Search methods Cochrane Central Register Controlled Trials (CENTRAL), Cochrane Effective Practice Organisation Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process Other Non-Indexed Citations), EMBASE, CINAHL, PsycINFO were searched up June 2014. We also handsearched selected journals from 2000 2012 scanned reference lists relevant reviews. Selection criteria We included individual or cluster-randomised controlled trials, non-randomised before-after studies comparing usual care over 16 years age diagnosis asthma. The had satisfy at least following five criteria: an organisational component targeting patients; professionals system, both; education support, active involvement two care; minimum duration three months. Data collection analysis After initial screen titles, review authors working independently assessed eligibility study quality; they extracted data. contacted obtain missing information additional data, where necessary. pooled results using random-effects model reported mean standardised differences (SMDs). Main results A total 20 including 81,746 (median 129.5) this review, follow-up ranging 3 12 months. Patients' was 42.5 years, 60% female, their mostly rated moderate severe. Overall low methodological quality, because limitations design wide confidence intervals certain results. Compared care, resulted improvements asthma-specific quality life (SMD 0.22, 95% interval (CI) 0.08 0.37), severity scores 0.18, CI 0.05 0.30), lung function tests 0.19, 0.09 0.30). data improvement self-efficacy inconclusive 0.51, -0.08 1.11). Results hospitalisations emergency department unscheduled visits could not be combined meta-analysis too heterogeneous; overall. Only few exacerbations, days off work school, use action plan, satisfaction. Meta-analyses performed these outcomes. Authors' conclusions There evidence can improve life, severity, tests. Overall, provide potential when compared care. However, optimal composition added value, alone usually offered asthma, need further investigation.