Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis.
Katelyn R Smalley, Lisa Aufegger, Kelsey Flott and 2 others
PMID 32912809WHAT IT FOUND
COPD self-management programmes did not consistently reduce hospital or GP visits.
Most utilisation results did not show a clear reduction, and more behaviour-change content did not predict better service use.
Key findings
01Across all healthcare utilisation outcomes in the included COPD self-management trials, most results were not statistically significant.
02The review found no clear association between the number of behaviour-change domains used in a programme and an effect on healthcare utilisation.
03The included studies were generally poor quality: one had good quality, nine moderate, 10 poor, and six very poor.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included 26 studies but does not give a total participant count. Outcome measures were too heterogeneous for meta-analysis, so the review used vote counting and cannot show the size of any effect. The included studies had mixed risk of bias: one study had good quality, nine moderate, 10 poor, and six very poor. Only 10 of 26 studies analysed outcomes in a way that introduced a low risk of bias. Most studies did not publish an a priori protocol, so reporting bias was unclear. Double-blinding of participants and personnel was not possible because these were behavioural interventions. Fidelity to the programmes was not observed, and the review relied on study authors' descriptions.
Declared interests
The work was funded by the National Institute for Health Research Imperial Patient Safety Translational Research Centre, with infrastructure support from the NIHR Imperial Biomedical Research Centre. The authors declared no competing interests.
The easy way to misread this
Do not conclude that COPD self-management programmes reliably reduce hospital or GP use. The few significant decreases were inconsistent, most outcomes were not significant, and the evidence quality was generally poor.