Follow-up of the Finnish Asthma Programme 2000–2010: reduction of hospital burden needs risk group rethinking

Kauppi, Paula; Linna, Miika; Martikainen, Jaana E.; Mäkelä, Mika J.; Haahtela, Tari

doi:10.1136/thoraxjnl-2011-201028

Cited by 46 publications

(69 citation statements)

References 7 publications

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“…Routine data over the decade of the intervention showed increased use of preventer medication and a reduction in hospital admissions and emergency visits, 232 which was maintained after the end of the programme. 233 The authors attributed the success of the initiative to positive attitudes from a committed health-care system, training of all professionals coming into direct patient contact and implementation of guided self-management.…”

Section: Primarily Organisational Changementioning

confidence: 99%

“…Defined whole eligible populations ranged from 135 to 6984. One study 232,233 reported a national initiative and an estimated population of 350,000 people with asthma. Participating populations ranged from 84 to 1895 participants.…”

Section: 233mentioning

confidence: 99%

“…We included 19 papers reporting 18 studies (see Table 116 for details) nine of which were conducted in the USA, 219,220,[222][223][224][225]230,231,234 four from the UK, 218,226,228,236 two from Brazil, 229,235 one (two reports) from Finland 232,233 and two from other European countries. 221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Three studies used population data to observe the impact of multifaceted public health programmes on admissions, 229,232,233,235 two quality improvement projects aimed to promote asthma self-management 230,236 and two complex interventions targeted low-income communities in US cities. 231,234 A national programme to improve asthma care in Finland 232,233 included a strong focus on self-management education, in the context of widespread professional education-and systems-level expectations of raising the quality of asthma diagnosis and management.…”

Section: Primarily Organisational Changementioning

confidence: 99%

“…228 Seven were based on longitudinal data, 220,223,[230][231][232][233][234][235] one with a control cohort, 229 and two uncontrolled before-and-after 221,236 or cross-sectional studies. 227 This resulted in substantial variation in quality assessment, ranging from 10 to 24 out of a possible score of 28.…”

Section: 233mentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Primarily Organisational Changementioning

confidence: 99%

Section: 233mentioning

confidence: 99%