Systematic meta-review of supported self-management for asthma: a healthcare perspective
Open accessAbstract
BACKGROUND: Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS: We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS: A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS: Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION: RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews.
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Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.
“Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.15–17”
From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [16]
The Background and Discussion describe supported self-management as established for asthma and other long-term conditions, not for several chronic painful disorders. A search for pain, migraine and headache found only a table mentioning one pain study; our copy does not address whether self-management is established for chronic painful disorders or lacking for chronic headache disorders. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Mancuso, C. A., Peterson, M. G. E., Gaeta, T. J., Fernández, J., Birkhahn, R., Melniker, L. A., & Allegrante, J. P. (2011) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.11.033 · Cited by 24 · see citing works
The Impacts of Educational Asthma Interventions in Schools: A Systematic Review of the Literature
Coelho, A. C. C., Cardoso, L. S. B., Souza‐Machado, C., et al. (2016) · Canadian Respiratory Journal · doi:10.1155/2016/8476206 · Cited by 24 · see citing works
Hoskins, G., Williams, B., Abhyankar, P., Donnan, P. T., Duncan, E., Pinnock, H., Pol, M. M. V. D., Rauchhaus, P., Taylor, A., & Sheikh, A. (2016) · Trials · doi:10.1186/s13063-016-1684-7 · Cited by 23 · see citing works
Self-citationIndigenous healthcare worker involvement for Indigenous adults and children with asthma
Chang, A. B., Taylor, B., Masters, I. B., Laifoo, Y., & Brown, A. D. H. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006344.pub2 · Cited by 21 · see citing works
Price, D., Haughney, J., Lloyd, A., et al. (2004) · Current Medical Research and Opinion · doi:10.1185/030079904x5409 · Cited by 17 · see citing works
Does a Written Asthma Action Plan Reduce Unscheduled Doctor Visits in Children?
Wong, S. S., Nathan, A. M., de Bruyne, J. A., Zaki, R. A., & Tahir, S. Z. M. (2012) · The Indian Journal of Pediatrics · doi:10.1007/s12098-012-0839-0 · Cited by 11 · see citing works
Marshall, W. (2012) · BMJ · doi:10.1136/bmj.e3685 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [8]Singh D Ham C Improving care for people with long-term conditions: a review of UK and international frameworks. NHS Institute for Innovation and Improvement 2006 Department of Health Birmingham
Cited by
Sorted by citations
Interventions to Support Behavioral Self-Management of Chronic Diseases
Allegrante, J. P., Wells, M. T., & Peterson, J. C. (2019) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040218-044008 · Cited by 502 · see citing works
Children’s sleep and health: A meta-review
Matricciani, L., Paquet, C., Galland, B., Short, M., & Olds, T. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.04.011 · Cited by 453 · see citing works
Wei, H., Horns, P., Sears, S. F., Huang, K., Smith, C. M., & Wei, T. L. (2022) · Journal of Interprofessional Care · doi:10.1080/13561820.2021.1973975 · Cited by 310 · see citing works
Captieux, M., Pearce, G., Parke, H. L., Epiphaniou, E., Wild, S., Taylor, S. J. C., & Pinnock, H. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024262 · Cited by 132 · see citing works
Self-citationShahaj, O., Denneny, D., Schwappach, A., Pearce, G., Epiphaniou, E., Parke, H. L., Taylor, S. J. C., & Pinnock, H. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000001867 · Cited by 110 · see citing works
Self-citationDigital Health Technology in Asthma: A Comprehensive Scoping Review
Mosnaim, G., Safioti, G., Brown, R., DePietro, M., Szefler, S. J., Lang, D. M., Portnoy, J. M., Bukstein, D. A., Bacharier, L. B., & Merchant, R. K. (2021) · The Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2021.02.028 · Cited by 117 · see citing works
Psychosocial adjustment to multiple sclerosis diagnosis: A meta-review of systematic reviews
Topcu, G., Griffiths, H., Bale, C., Trigg, E., Clarke, S., Potter, K.-J., Mhizha-Murira, J. R., Drummond, A., Evangelou, N., Fitzsimmons, D., et al. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101923 · Cited by 50 · see citing works
“limitation to meta-reviews is that they can only report on studies that has previously been captured in published or grey literature (Harvey et al., 2017; Pinnock et al., 2017), meaning”
BackgroundPatel, S., Achana, F., Carnes, D., Eldridge, S., Ellard, D. R., Griffiths, F., Haywood, K., Hee, S. W., Mistry, D., Mistry, H., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033520 · Cited by 24 · see citing works
Self-citationHui, C. Y., McKinstry, B., Fulton, O., Buchner, M., & Pinnock, H. (2021) · Journal of Medical Internet Research · doi:10.2196/22432 · Cited by 17 · see citing works
Self-citation
- Authors
- groups, F. T. P. A. R., Pinnock, H., Parke, H. L., Panagioti, M., Daines, L., Pearce, G., Epiphaniou, E., Bower, P., Sheikh, A., Griffiths, C. J., & Taylor, S. J. C.
- Affiliations
- Asthma UK Centre for Applied Research (GB)
- University of London (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Pinnock, Hilary
- ORCID
- Venue
- BMC Medicine
- Published
- 2017-03-17
- Volume
- 15
- Issue
- 1
- Pages
- 64-64
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC5356253
- OpenAlex
- W2594148781
- Cited by
- 291
- References
- 98
- Citations by year
- 2026: 18 · 2025: 24 · 2024: 35 · 2023: 35 · 2022: 32 · 2021: 51 · 2020: 35 · 2019: 30 · 2018: 20 · 2017: 10 · 2016: 1
- FWCI
- 19.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Pure (Coventry University) (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Funders
- Health Services and Delivery Research Programme (11/1014/04, 11/1014/06)
- Chief Scientist Office (PCRCA_08_01)
- Scottish School of Primary Care (Academic Fellowship in General Practice)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- asthma, self-management support, asthma action plan, patient education, health care utilization, hospitalization, unscheduled care, asthma control, health care costs, long-term condition management, implementation, quality of life
- MeSH terms
- Asthma, Delivery of Health Care, Hospitalization, Humans, Quality of Life, Self Care, Health Care Costs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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