Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis

Area of Science:

• Health Services Research
• Behavioral Science
• Respiratory Medicine

Background:

• Chronic Obstructive Pulmonary Disease (COPD) management requires effective patient self-care strategies.
• Self-management programmes (SMPs) aim to improve health outcomes and reduce healthcare utilization in COPD patients.
• Evaluating the impact of SMP design on healthcare-seeking behaviors is crucial for optimizing interventions.

Purpose of the Study:

• To assess the effectiveness of SMPs in modifying healthcare-seeking behaviors among individuals with COPD.
• To explore the relationship between the design elements of SMPs and their impact on healthcare utilization.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) focusing on SMPs for COPD.
• Healthcare utilization, including hospitalization rates, was the primary outcome measure.
• The Theoretical Domains Framework (TDF) was employed to analyze the design components of the reviewed SMPs.

Main Results:

• Nineteen SMPs were identified across 26 papers, with hospitalization being the most frequent outcome measured.
• A significant reduction in hospitalizations was observed in 5 of the reviewed SMPs.
• While all SMPs incorporated at least five TDF domains, 'skills' and 'behavioral regulation' were universally present, no clear association between TDF domains and utilization was found.
• The overall quality of the included studies was rated as moderate to poor.

Conclusions:

• There is a need for greater consistency in the objectives, design, and evaluation methodologies of SMPs for COPD.
• The TDF offers a valuable framework for guiding the development and assessment of future SMPs.
• Improved trial design and reporting are essential to demonstrate the clinical and economic benefits of SMPs for healthcare practices.