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Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis |
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| Authors: | Peytremann-Bridevaux Isabelle Staeger Philippe Bridevaux Pierre-Olivier Ghali William A Burnand Bernard |
| Affiliation: | aInstitute of Social and Preventive Medicine, Healthcare Evaluation Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland bDepartment of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland cDivision of Pulmonary Care, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland dDepartments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada eGroupe de Recherche en Gestion Thérapeutique, Faculté de Médecine, Université de Montréal, Canada. |
| Abstract: | BackgroundDisease-management programs may enhance the quality of care provided to patients with chronic diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to assess the effectiveness of COPD disease-management programs.MethodsWe conducted a computerized search of MEDLINE, EMBASE, CINAHL, PsychINFO, and the Cochrane Library (CENTRAL) for studies evaluating interventions meeting our operational definition of disease management: patient education, 2 or more different intervention components, 2 or more health care professionals actively involved in patients' care, and intervention lasting 12 months or more. Programs conducted in hospital only and those targeting patients receiving palliative care were excluded. Two reviewers evaluated 12,749 titles and fully reviewed 139 articles; among these, data from 13 studies were included and extracted. Clinical outcomes considered were all-cause mortality, lung function, exercise capacity (walking distance), health-related quality of life, symptoms, COPD exacerbations, and health care use. A meta-analysis of exercise capacity and all-cause mortality was performed using random-effects models.ResultsThe studies included were 9 randomized controlled trials, 1 controlled trial, and 3 uncontrolled before-after trials. Results indicate that the disease-management programs studied significantly improved exercise capacity (32.2 m, 95% confidence interval [CI], 4.1-60.3), decreased risk of hospitalization, and moderately improved health-related quality of life. All-cause mortality did not differ between groups (pooled odds ratio 0.84, 95% CI, 0.54-1.40).ConclusionCOPD disease-management programs modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality. Future studies should explore the specific elements or characteristics of these programs that bring the greatest benefit. |
| Keywords: | Chronic obstructive pulmonary disease Disease management Effectiveness Meta-analysis Systematic review Quality of care |
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