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A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis.

ABSTRACT: Introduction: Chronically ill people are confronted with significant challenges when dealing with health care services. Lay-led self-management programs aim to improve self-management skills and might enable patients to make appropriate decisions as to when to use health care services. Contrary to the general attitude that self-management programs reduce health care utilisation, we suspect that better self-management skills lead to increased or possibly more appropriate health care utilisation. Our review and meta-analysis sheds light on the relationship between lay-led self-management programs and health care utilisation. Methods: In March 2017, we searched 7 databases (CDSR, DARE, HTA, Medline, CINAHL, PsycInfo, and SSCI) to perform a systematic review and meta-analysis to identify studies that reported empirical data on lay-led self-management programs and health care utilisation. We extracted the characteristics of all primary studies and the data of four indicators of utilisation (physician visits, emergency department visits, hospital admissions, and length of stay in hospital), and analysed the role of health care utilisation in these studies. We present the results in frequency tables and as a conventional meta-analysis with the standardized mean difference (SMD), 95% confidence intervals (CI), and pooled overall effect sizes using RevMan 5.3.5. The manuscript follows the PRISMA checklist. Results: Overall, we include 49 primary studies; 10 studies provided sufficient data for the meta-analysis. Health care utilisation played a different role in the studies; 15 studies reported a clear explicit hypothesis on the influence of a lay-led self-management program on health care utilisation, and 17 studies assumed an implicit assumption. 8 studies discussed the possibility that a lay-led self-management program could lead to more appropriate health care utilisation. The meta-analysis showed mixed results, and many effect sizes were not statistically significant. The participants of a lay-led self-management program had fewer emergency department visits (SMD: -0.08; 95% CI: -0.15 to -0.01; p=0.02) than the control group. Conclusion: Although the statistically significant effects of the meta-analysis are low, our overall findings show that only a small number of the included studies tackled the task of comprehensively investigating self-management skills in the context of health care utilisation. This fails to do justice to the potential of self-management programs. It is essential to consider the appropriateness of health care utilisation. We propose the term self-management-sensitive utilisation for this purpose.

SUBMITTER: Lederle M

PROVIDER: S-EPMC6533545 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis.

Lederle Mareike M Bitzer Eva-Maria EM

German medical science : GMS e-journal 20190416

<b>Introduction:</b> Chronically ill people are confronted with significant challenges when dealing with health care services. Lay-led self-management programs aim to improve self-management skills and might enable patients to make appropriate decisions as to when to use health care services. Contrary to the general attitude that self-management programs reduce health care utilisation, we suspect that better self-management skills lead to increased or possibly more appropriate health care utilis ...[more]

PMID: 31148954

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Project description:With a near 20-year developmental history as an evidence-based program, the suite of Chronic Disease Self-Management Education (CDSME) programs were selected in 2010 for grand-scale dissemination in a federally supported initiative to improve the health of older Americans. The primary charge of this national effort was to establish a sustainable program delivery system for empowering American adults with one or more chronic conditions to better manage their health. The current study focused on a series of dissemination and implementation science research questions to: (1) examine the geographic distribution of participation in this initiative across the Unites States; (2) describe workshop characteristics engaged to reach program participants in various settings; and (3) describe personal characteristics of the first 100,000 participants. Each subsequent entering cohort was descriptively examined to indicate whether there was constancy or change in delivery sites and populations reached over time. Findings show a strengthening of the workshop delivery infrastructure in that it took 9.4?months to reach the first 25,000 participants in 853 counties compared to 5.4?months to reach the last 25,000 participants in 1,109 counties. The workshop delivery characteristics and participant characteristics remained relatively consistent across increments of 25,000 participants reached, although general trends were observed for some variables. For example, after reaching the first 25,000 participants, subsequent groups of 25,000 participants were reached more quickly. Additionally, workshops were increasingly delivered in ZIP Codes with higher percentages of families residing below the federal poverty line. As more participants were reached, more participants with chronic conditions were enrolled. This national translational study illustrates the rapid expansion of CDSME programs throughout the United States and capability to reach diverse populations in a variety of settings.

Project description:BackgroundThe COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may have profound effects on their mental and physical health, personal relationships and professional efficacy.MethodsWith mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria.ResultsA total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms.ConclusionIt is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19's impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as 'compensatory' to one another, with coping mechanisms buffering and fortifying the physician's overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures.

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A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis.

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A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis.

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