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Cited by 132Health Policy Implementation ScienceClinical practice guidelines implementationAsthma and respiratory diseases

The DOI matches its Crossref record; 47 of the 49 references it cites were found in a registry or an index.

Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies

Open access
Pinnock, Hilary, Epiphaniou, Eleni, Pearce, Gemma, Parke, Hannah, Greenhalgh, Trish, Sheikh, Aziz, Griffiths, Chris J., Taylor, Stephanie J. C.·2015·BMC Medicine
DOI 10.1186/s12916-015-0361-0PMC PMC4465463
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Abstract

BACKGROUND: Asthma self-management remains poorly implemented in clinical practice despite overwhelming evidence of improved healthcare outcomes, reflected in guideline recommendations over three decades. To inform delivery in routine care, we synthesised evidence from implementation studies of self-management support interventions. METHODS: We systematically searched eight electronic databases (1980 to 2012) and research registers, and performed snowball and manual searches for studies evaluating implementation of asthma self-management in routine practice. We included, and adapted systematic review methodology to reflect, a broad range of implementation study designs. We extracted data on study characteristics, process measures (for example, action plan ownership), asthma control (for example, patient reported control questionnaires, days off school/work, symptom-free days) and use of health services (for example, admissions, emergency department attendances, unscheduled consultations). We assessed quality using the validated Downs and Black checklist, and conducted a narrative synthesis informed by Kennedy's whole systems theoretical approach (considering patient, practitioner and organisational components and the interaction between these). RESULTS: We included 18 studies (6 randomised trials, 2 quasi-experimental studies, 8 with historical controls and 3 with retrospective comparators) from primary, secondary, community and managed care settings serving a total estimated asthma population of 800,000 people in six countries. In these studies, targeting professionals (n = 2) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (n = 6) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organisation (n = 3) improved process measures, but had little/no effect on clinical outcomes. Interventions that explicitly addressed patient, professional and organisational factors (n = 7) showed the most consistent improvement in both process and clinical outcomes. Authors highlighted the importance of health system commitment, skills training for professionals, patient education programmes supported by regular reviews, and on-going evaluation of implementation effectiveness. CONCLUSIONS: Our methodology offers an exemplar of reviews synthesising the heterogeneous implementation literature. Effective interventions combined active engagement of patients, with training and motivation of professionals embedded within an organisation in which self-management is valued. Healthcare managers should consider how they can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (registration number: CRD42012002898 ) Accessed 24 May 2015.

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Crossref · 10.1186/s12916-015-0361-0

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Fig. 1 Hierarchy of implementation studies. Hierarchy based on: 1. Randomisation, status of comparator groups. 2. Prospective/retrospective design. These categories overlap. Other factors (such as size and generalisability of the population studied) will influence the robustness of the evidence
Fig. 1 Hierarchy of implementation studies. Hierarchy based on: 1. Randomisation, status of comparator groups. 2. Prospective/retrospective design. These categories overlap. Other factors (such as size and generalisability of the population studied) will influence the robustness of the evidenceCC BY · PubMed Central
Fig. 2 PRISMA flowchart. Note: The initial searches were combined for all the 14 LTCs in the PRISMS overview [22]. The figures for asthma are provided from the point of full text screening. LTCs, long term conditions
Fig. 2 PRISMA flowchart. Note: The initial searches were combined for all the 14 LTCs in the PRISMS overview [22]. The figures for asthma are provided from the point of full text screening. LTCs, long term conditionsCC BY · PubMed Central
Fig. 3 Harvest plots [29] illustrating the effectiveness on process and clinical outcomes of self-management implementation. Notes: Each bar represents a study categorised as primarily targeting patients, professionals or the organisation, or a whole systems approach explicitly targeting all three. The colour, height and number indicate the three criteria for assessing weight of evidence of individual trials. The colour of the bar indicates the study design with the more robust methodologies in darker colours. The height of the line illustrates the number of patients included in the study and the number is the Downs and Black quality score. The decisions which underpin this plot are detailed in Additional file 5
Fig. 3 Harvest plots [29] illustrating the effectiveness on process and clinical outcomes of self-management implementation. Notes: Each bar represents a study categorised as primarily targeting patients, professionals or the organisation, or a whole systems approach explicitly targeting all three. The colour, height and number indicate the three criteria for assessing weight of evidence of individual trials. The colour of the bar indicates the study design with the more robust methodologies in darker colours. The height of the line illustrates the number of patients included in the study and the number is the Downs and Black quality score. The decisions which underpin this plot are detailed in Additional file 5CC BY · PubMed Central

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Research works printed but not linked: 6

  1. Department of Health. Quality, innovation, productivity and prevention (QIPP) work-stream for patients with LTCs. London: Department of Health; 2010.
  2. Asthma UK. Time to take action on asthma. London: Asthma UK; 2014. http://www.asthma.org.uk/takeaction . Accessed 5 Jan 2015.
  3. Centers for Disease Control and Prevention. Asthma Facts—CDC’s National Asthma Control Program Grantees. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2013.
  4. Cooksey D. A review of UK health research funding. London: Her Majesty’s Stationery Office; 2006.
  5. Reeves BC, Deeks JJ, Higgins JP, Wells GA, on behalf of the Cochrane Non-Randomised Studies Methods Group. Including non-randomized studies (Chapter 13). In: Cochrane Handbook. http://handbook.cochrane.org . Accessed 1 Oct 2014
  6. Effective Practice and Organisation of Care (EPOC) Review Group. What study designs should be included in an EPOC review and what should they be called? http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/EPOC%20Study%20Designs%20About.pdf . Accessed 24 May 2015.

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Metadata

Authors
Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H., Greenhalgh, T., Sheikh, A., Griffiths, C. J., & Taylor, S. J. C.
Affiliations
  • Asthma UK Centre for Applied Research (GB)
  • Queen Mary University of London (GB)
  • Coventry University (GB)
Corresponding author
Pinnock, Hilary
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2015-06-01
Volume
13
Issue
1
Pages
127-127
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-015-0361-0
PMC
PMC4465463
OpenAlex
W1782036681
Cited by
132
References
49
Citations by year
2026: 5 · 2025: 7 · 2024: 16 · 2023: 16 · 2022: 9 · 2021: 7 · 2020: 16 · 2019: 16 · 2018: 9 · 2017: 16 · 2016: 10 · 2015: 5
FWCI
2.39
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure (Coventry University) (publishedVersion, cc-by)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • Coventry University Open Collections (Coventry university) (submittedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
  • The Open Collections (Coventry University) (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0512-10031, 11/1014/04)
  • Asthma and Lung UK
  • Asthma UK Centre for Applied Research
  • Health Services and Delivery Research Programme (11/1014/04)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Keywords
asthma, self-management, implementation, asthma control, health care utilization, patient education, professional training, organizational change, whole systems approach, usual care
MeSH terms
Asthma, Female, Humans, Surveys and Questionnaires, Retrospective Studies, Self Care

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