Hardiker, NR, Grant, MJ and Jones, I
Self management of long term conditions: A literature review
, Project Report,
University of Salford, Salford.
A number of policy documents have been published recently that support the principle of self care and self management and call for ‘implementation’. Partners across the north west of England are working together, through the development of a pilot service, to reduce emergency readmissions of patients with long-term conditions while simultaneously improving quality and outcomes. In order to inform this work, this study has drawn on published evidence around self-management, with a particular focus on people living with chronic obstructive pulmonary disease and/or heart failure in urban areas of high-deprivation, to allow a comparison between the model that underpins the pilot service and other reported models of self-management, including how these models are delivered, their impact in terms of patient outcomes, and their relative cost-effectiveness.
A total of 79 articles (identified from among 923 abstracts) were included in the literature review. Each article fell into one of five themes. The majority of articles fell within the education or counselling theme, followed by personal plans, education or counselling with exercise, telehealth and exercise only.
The results for all studies of exercise only interventions were positive, demonstrating increased activity/ exercise, improved quality of life and self-efficacy, and improved status.
Personal plans appear to have made a positive impact in the majority of studies, particularly in terms of hospitalisations and health care utilisation, status and outcomes and behaviour.
For those studies that described a combination of education or counselling with an exercise programme, the results were largely positive (particularly in terms of status or outcome).
The range of education or counselling interventions (without exercise) appear to have made a modest positive impact in the majority of cases (particularly in terms of behaviour and status and outcomes).
While some studies showed positive effects from the use of telehealth, no difference between control and intervention groups was reported more often.
Only one study included any negative effect – increased exacerbations for the intervention group in a combined educational/counselling and exercise, although the reasons for this are unclear.
In all cases, there was no identifiable predictor for any positive (or negative) effect, although most educational/counselling interventions (with or without exercise) involved human contact and many provided some degree of ongoing support.
The majority of interventions to support self-management appear to make some positive impact in terms of behaviour, status, outcome, use of health services or quality of life; there is also some indication, albeit limited that costs of care can be reduced as a result. However, due to the heterogeneous nature of the interventions in published reports, further primary research is needed to identify common predictors of success and the longevity of success.
The findings from a number of relevant previous literature reviews support the findings from this review.
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