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Patients with chronic obstructive pulmonary disorder (COPD) who receive self-management support within six weeks of hospital discharge may have slightly improved quality of life, but more evidence is needed

Jordan RE, Majothi S, Heneghan NR, et al. Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): An evidence synthesis and economic analysis Health Technology Assessment. 2015 May:19(36)

Review question

Which self-management support interventions, delivered after discharge from hospital for patients with COPD, improve health-related outcomes, decrease re-admission rates and are a more cost-effective intervention compared to usual care?

Background

While self-management interventions for COPD can improve health-related quality of life (HRQoL) and reduce hospital admissions, the specifics regarding its application vary considerably.

Though patients may believe they understand COPD and the associated prognosis, treatment and management, the true extent to which they manage their condition is highly variable and oftentimes suboptimal.

This systematic review aimed to synthesize the wide variety of literature in an attempt to determine the effectiveness of self-management support in dealing with COPD, particularly within six weeks of hospital discharge.

How the review was done

A detailed search of a number of electronic databases for studies published up until 2012 was conducted. Studies that focused on the effectiveness of self-management interventions among patients with COPD were included in the review.

A total of 13,355 studies were identified in searches and 186 were included in the review after assessments for eligibility.

This review was funded by the Health Technology Assessment Programme (U.K.).

What the researchers found

This study found limited evidence that self-management support delivered within six weeks after discharge lessens re-admission rates and improves health outcomes. However, these results should be taken with discretion due to constraints in study design.

One of the included studies suggested that self-management support is more effective than standard treatment, but costlier.

Structured exercise and interventions with three or more combined components were shown to have some potential benefits, although it was not clear from the included studies which components were most effective.

Conclusion

This review suggests that self-management support after discharge in the context of COPD may have potential benefits to health outcomes and provide a cheaper alternative to usual care, but evidence is limited and results are inconclusive. More research is needed before robust conclusions about the best approaches for self-management support can be made.