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Care models in the management of haemophilia: a systematic review.

ABSTRACT: Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes.To conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH).We searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the field, and reviewed reference lists.Randomized and non-randomized studies of PWH or carriers, focusing mainly on the assessment of care models on delivery.Two investigators independently screened title, abstract, and full text of retrieved articles for inclusion. Risk of bias and overall quality of evidence was assessed using Cochrane's ACROBAT-NRSI tool and GRADE respectively. Relative risks, mean differences, proportions, and means and their variability were calculated as appropriate.27 non-randomized studies were included: eight comparative and 19 non-comparative studies. We found low- to very low-quality evidence that in comparison to other models of care, integrated care may reduce mortality, hospitalizations and emergency room visits, may lead to fewer missed days of school and work, and may increase knowledge seeking.Our comprehensive review found low- to very low-quality evidence from a limited number of non-randomized studies assessing the impact of haemophilia care models on some patient-important outcomes. While the available evidence suggests that adoption of the integrated care model may provide benefit to PWH, further high-quality research in the field is needed.

SUBMITTER: Yeung CH

PROVIDER: S-EPMC5283751 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Care models in the management of haemophilia: a systematic review.

Yeung C H T CH Santesso N N Pai M M Kessler C C Key N S NS Makris M M Navarro-Ruan T T Soucie J M JM Schünemann H J HJ Iorio A A

Haemophilia : the official journal of the World Federation of Hemophilia 20160701

<h4>Background</h4>Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes.<h4>Objective</h4>To conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH).<h4>Search methods</h4>We searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the fie ...[more]

PMID: 27348399

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Project description:BACKGROUND:Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema. METHODOLOGY/PRINCIPAL FINDINGS:Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured. CONCLUSIONS/SIGNIFICANCE:There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people with CR-LE. Empowerment of people with lymphedema to care for themselves with access to supportive professional assistance has the capacity to optimise self-management practices and improve outcomes from limited health resources.

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Care models in the management of haemophilia: a systematic review.

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Care models in the management of haemophilia: a systematic review.

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