The National Institute for Health Research has highlighted a study which states that people with asthma who receive supported self-management are less likely to attend A&E or be admitted to hospital. The interventions are unlikely to increase overall costs for healthcare services. Those who self-manage are also likely to have more controlled asthma and a better quality of life.
This extensive overview of systematic reviews included evidence from 270 randomised controlled trials exploring the effects of asthma self-management on healthcare utilisation and costs. Self-management programmes were slightly more expensive, but this cost was likely to be offset by reducing unplanned medical visits and improving patient quality of life.
Trials covered different self-care education programmes delivered in a range of contexts. However, programmes which included written action plans supported by regular professional review were found to be most beneficial.
What did the study find?
- Six moderate to high quality reviews found that supported self-management reduced hospital admissions, with relative risks ranging from 0.50 to 0.79 compared to the control group. This suggests that admissions could be reduced by about one quarter to a half. Another six reviews, of variable quality, found inconsistent effects.
- Four moderate to high quality reviews found a reduction in A&E attendances, with significant relative risks ranging from 0.73 to 0.82. Four narrative reviews found an effect in at least half of their trials, one review showed inconsistent results and one showed no benefit.
- Three high quality reviews found that people receiving supported self-management had fewer unscheduled consultations, with relative risks of around 0.68. Three moderate quality reviews found an effect in at least half of their trials, while two poor quality reviews had inconsistent results.
- Looking at target groups and healthcare contexts, some reviews found a benefit of culture-specific programmes and those targeting children. Interventions involving education, action plans and regular professional review were most beneficial.
- The RECURSIVE economic review (24 trials, 7061 participants) showed that self-management was more costly than usual care. The researchers report that the cost is likely to be offset by savings from reduced healthcare utilisation and conclude that overall it does not lead to significant increases in total healthcare costs.
These findings are in keeping with current guideline recommendations and emphasise that supported self-management programmes for asthma should be prioritised.
The original study can be found here:
Systematic meta-review of supported self-management for asthma: a healthcare perspective
BMC Medicine, 2017, Volume 15, Number 1, Page 1