Meta-analysis of self-management education for patients with chronic obstructive pulmonary disease

• Main Authors: Hurley J, Gerkin RD, Fahy B, Robbins RA
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2012-06-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: chronic obstructive pulmonary disease; education; emergency room visits; hospitalizations; meta-analysis; mortality; self-management; stopping studies early
• Online Access: http://www.swjpcc.com/pulmonary/2012/6/9/meta-analysis-of-self-management-education-for-patients-with.html

BackgroundChronic obstructive pulmonary disease (COPD) is a common disease frequently associated with high use of health services. Self-management education is a term applied to programs aimed at teaching patients skills that promote the self-efficacy needed to carry out medical regimens specific to control their disease. In COPD, the value of self-management education is not yet clear and a recent trial was terminated early because of excess mortality in the intervention group.ObjectivesThe objective of this meta-analysis was to assess the settings, methods and efficacy of COPD self-management education programs on patient outcomes and healthcare utilization.Selection criteriaRandomized controlled trials of self-management education in patients with COPD were identified. Studies focusing primarily on comprehensive pulmonary rehabilitation (education and exercise) and studies without usual care as a control group were excluded.Search strategyWe searched PubMed (January 1985 to May 2012) as well as other meta-analysis and reviews.Data collection and analysisTwo reviewers (JH and RAR) independently assessed study quality and extracted data. Investigators were contacted for additional information.Main resultsThe reviewers included 3 group comparisons drawn from 12 trials. The studies showed no significant change in mortality, with one study being an outlier compared to the others. However, the meta-analysis revealed a reduction in the probability of hospital admission among patients receiving self-management education compared to those receiving usual care.ConclusionsIt is likely that self-management education is associated with a reduction in hospital admissions with no change in mortality. However, because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the preferred curriculum and delivery method of self-management education programs in COPD.