This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (98)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Patient Education/ Health Literacy  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review and Methodological Critique of the Literature

Asra Warsi, BA; Philip S. Wang, MD, DrPH; Michael P. LaValley, PhD; Jerry Avorn, MD; Daniel H. Solomon, MD, MPH

Arch Intern Med. 2004;164:1641-1649.

Background  Self-management programs have been widely reported to help patients manage symptoms and contain utilization of health care resources for several chronic conditions, but to date no systematic review across multiple chronic diseases has been reported. We evaluated the efficacy of patient self-management educational programs for chronic diseases and critically reviewed their methodology.

Methods  We searched MEDLINE and HealthSTAR for the period January 1, 1964, through January 31, 1999, then hand searched the reference section of each article for other relevant publications. We included studies if a self-management education intervention for a chronic disease was reported, a concurrent control group was included, and clinical outcomes were evaluated. Two authors reviewed each study and extracted the data on clinical outcomes.

Results  We included 71 trials of self-management education. Trial methods varied substantially and were suboptimal. Diabetic patients involved with self-management education programs demonstrated reductions in glycosylated hemoglobin levels (summary effect size, 0.45; 95% confidence interval [CI], 0.17-0.74); diabetic patients had improvement in systolic blood pressure (summary effect size, 0.20; 95% CI, 0.01-0.39); and asthmatic patients experienced fewer attacks (log rate ratio, 0.59; 95% CI, 0.35-0.83). Although we found a trend toward a small benefit, arthritis self-management education programs were not associated with statistically significant effects. Evidence of publication bias existed.

Conclusions  Self-management education programs resulted in small to moderate effects for selected chronic diseases. In light of evidence of publication bias, further trials that adhere to a standard methodology would help clarify whether self-management education is worthwhile.

From the Divisions of Pharmacoepidemiology and Pharmacoeconomics (Ms Warsi and Drs Wang, Avorn, and Solomon) and Rheumatology, Immunology, and Allergy (Dr Solomon), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, and Boston University School of Public Health, Boston (Dr LaValley). The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Two Self-management Interventions to Improve Hypertension Control: A Randomized Trial
Bosworth et al.
ANN INTERN MED 2009;0:0000605-200911170-00148v1-E-148.
ABSTRACT | FULL TEXT  

Responsiveness of the Effective Consumer Scale (EC-17)
SANTESSO et al.
The Journal of Rheumatology 2009;36:2087-2091.
ABSTRACT | FULL TEXT  

The Effects of a Disease Management Program on Self-Reported Health Behaviors and Health Outcomes: Evidence From the "Florida: A Healthy State (FAHS)" Medicaid Program
Morisky et al.
Health Educ Behav 2009;36:505-517.
ABSTRACT  

Quality Improvement Strategies for Children With Asthma: A Systematic Review
Bravata et al.
Arch Pediatr Adolesc Med 2009;163:572-581.
ABSTRACT | FULL TEXT  

Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures
Meng et al.
The Gerontologist 2009;49:407-417.
ABSTRACT | FULL TEXT  

UK self-care support initiatives for older patients with long-term conditions: a review
Berzins et al.
Chronic Illness 2009;5:56-72.
ABSTRACT  

Patient and public involvement in chronic illness: beyond the expert patient
Greenhalgh
BMJ 2009;338:b49-b49.
FULL TEXT  

An 8-yr follow-up of Arthritis Self-Management Programme participants
Barlow et al.
Rheumatology (Oxford) 2009;48:128-133.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2009
American Diabetes Association
Diabetes Care 2009;32:S13-S61.
FULL TEXT  

A model to evaluate quality and effectiveness of disease management
Lemmens et al.
Qual Saf Health Care 2008;17:447-453.
ABSTRACT | FULL TEXT  

Healthy ChangesTM for Living With Diabetes: An Evidence-Based Community Diabetes Self-management Program
Klug et al.
The Diabetes Educator 2008;34:1053-1061.
ABSTRACT | FULL TEXT  

Short-Term Effects of a Self-Management Intervention on Health Status of Housebound Older Adults With Arthritis
Laforest et al.
Journal of Applied Gerontology 2008;27:539-567.
ABSTRACT  

Nutritionist Visits, Diabetes Classes, and Hospitalization Rates and Charges: The Urban Diabetes Study
Robbins et al.
Diabetes Care 2008;31:655-660.
ABSTRACT | FULL TEXT  

Beyond Good Intentions: the development and evaluation of a proactive self-management course for patients recently diagnosed with Type 2 diabetes
Thoolen et al.
Health Educ Res 2008;23:53-61.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2008
American Diabetes Association
Diabetes Care 2008;31:S12-S54.
FULL TEXT  

Effects of Quality Improvement Strategies for Type 2 Diabetes in Bronx, N.Y.
Boucai and Zonszein
Clin. Diabetes 2007;25:155-159.
FULL TEXT  

Effectiveness of strategies for informing, educating, and involving patients
Coulter and Ellins
BMJ 2007;335:24-27.
FULL TEXT  

Accountability for patient self-management of chronic conditions; ethical analysis and a proposal
Redman
Chronic Illness 2007;3:88-95.
ABSTRACT  

Standards of Medical Care in Diabetes--2007
American Diabetes Association
Diabetes Care 2007;30:S4-S41.
FULL TEXT  

Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.
Shojania et al.
JAMA 2006;296:427-440.
ABSTRACT | FULL TEXT  

Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial
Staab et al.
BMJ 2006;332:933-938.
ABSTRACT | FULL TEXT  

Self-Management Education for Osteoarthritis
Chodosh et al.
ANN INTERN MED 2006;144:617-618.
FULL TEXT  

Standards of Medical Care in Diabetes-2006
American Diabetes Association
Diabetes Care 2006;29:S4-S42.
FULL TEXT  

Patient, physician and self-management of chronic disease
Mainous
Chronic Illness 2005;1:275-276.
 

Empowering patients with diabetes: a qualitative primary care study focusing on South Asians in Leicester, UK
Stone et al.
Fam Pract 2005;22:647-652.
ABSTRACT | FULL TEXT  

Meta-Analysis: Chronic Disease Self-Management Programs for Older Adults
Chodosh et al.
ANN INTERN MED 2005;143:427-438.
ABSTRACT | FULL TEXT  

Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults
Two Feathers et al.
AJPH 2005;95:1552-1560.
ABSTRACT | FULL TEXT  

Ecological Approaches to Self-Management: The Case of Diabetes
Fisher et al.
AJPH 2005;95:1523-1535.
ABSTRACT | FULL TEXT  

Challenges in Systematic Reviews of Educational Intervention Studies
Reed et al.
ANN INTERN MED 2005;142:1080-1089.
ABSTRACT | FULL TEXT  

Identifying Individuals with a Reduced GFR Using Ambulatory Laboratory Database Surveillance
Garg et al.
J. Am. Soc. Nephrol. 2005;16:1433-1439.
ABSTRACT | FULL TEXT  

Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review
Garg et al.
JAMA 2005;293:1223-1238.
ABSTRACT | FULL TEXT  

Patient Education and Advocacy Groups: A Means to Better Outcomes?
Gordon
Arch Dermatol 2005;141:80-81.
FULL TEXT