Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis.

TitleEffectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2008
AuthorsPeytremann-Bridevaux, I, Staeger, P, Bridevaux, P-O, Ghali, WA, Burnand, B
JournalAm J Med
Volume121
Issue5
Pagination433-443.e4
Date Published2008 May
DOI10.1016/j.amjmed.2008.02.009
ISSN1555-7162
KeywordsAmbulatory Care, Disease Management, Humans, Pulmonary Disease, Chronic Obstructive
Abstract

BACKGROUND: Disease-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.

METHODS: We 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.

RESULTS: The 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).

CONCLUSION: COPD 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.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/18456040?dopt=Abstract

Alternate JournalAm. J. Med.
Citation Key / SERVAL ID2631
PubMed ID18456040

                         

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