Impact of a chronic care model based on patient empowerment on the management of Type 2 diabetes: effects of the SINERGIA programme

Musacchio, Nicoletta; Scher, Anat; Giancaterini, Annalisa; Pessina, Laura; Salis, Giovanni; Schivalocchi, F.; Nicolucci, Antonio; Pellegrini, Fabio; Rossi, Maria Chiara

doi:10.1111/j.1464-5491.2011.03253.x

Cited by 42 publications

(63 citation statements)

References 24 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Five papers reporting three studies focused on T1DM, [251][252][253][254][255] eight focused on T2DM, [246][247][248][249][250]260,261,264 the remaining 15 included mixed populations. [237][238][239][240][241][242][243][244][245][256][257][258][259]262,263 Thirteen of the studies were conducted in the USA, [237][238][239][244][245][246][247][248][256][257][258][259]262 one in the UK, 240 three from Germany (in five papers), 251,[253][254][255]260 three from Austria, 250,…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Specific examples which provide evidence of the effectiveness of this approach are a major national programme to improve asthma in Finland, 232 an initiative to improve asthma care in Brazil, 235 a programme to improve asthma care in Scotland, 236 COPD quality improvement programme in the USA, 275 diabetes quality improvement programmes in the USA 259 and Canada, 263 integrated stroke care in Hawaii, 278 and four studies which implemented self-management for diabetes in the context of the CCM. 237,256,262,264 Moullec et al's review 128 specifically addressed the role of setting in the context of adherence to asthma treatment by comparing RCTs which had provided one of more components of the CCM. The review concluded that the more CCM components included within interventions, the greater the effects on ICS adherence.…”

Section: The Pivotal Role Of Organisational Supportmentioning

confidence: 99%

“…Musacchio et al, 264 in Italy, explored the effectiveness of a multifaceted intervention based on the CCM. The programme aimed to engage all professionals with whom the patient interacted to implement the empowerment philosophy.…”

Section: Implementation Systematic Reviewmentioning

confidence: 99%

“…[237][238][239][240][241][242][243][244][245][256][257][258][259]262,263 Thirteen of the studies were conducted in the USA, [237][238][239][244][245][246][247][248][256][257][258][259]262 one in the UK, 240 three from Germany (in five papers), 251,[253][254][255]260 three from Austria, 250,252,261 four from Australia, [241][242][243]249 and one each from Canada 263 and Italy. 264 About half (n = 12) were conducted in primary care or community settings, [239][240][241]246,247,…”

Section: Description Of the Studiesmentioning

confidence: 99%

See 3 more Smart Citations

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

331

455

View full text Add to dashboard Cite

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.

show abstract

Section: Description Of the Studiesmentioning

confidence: 99%

Section: The Pivotal Role Of Organisational Supportmentioning

confidence: 99%

Section: Implementation Systematic Reviewmentioning

confidence: 99%

Section: Description Of the Studiesmentioning

confidence: 99%

See 2 more Smart Citations

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

331

455

View full text Add to dashboard Cite

show abstract

“…An Italian evaluation of the clinical effectiveness of a program, SINERGIA, was designed to help stable patients manage their type 2 diabetes, thereby decreasing unnecessary demand on limited specialist resources and contributing to a sustainable health system. 45 The rationale for this study is interesting in terms of aiming at reducing unnecessary demand for physicians. It posits that if patients with stable diabetes can be empowered to self-manage their disease through this patient-focused intervention, then expert clinical personnel can be freed to serve sicker patients.…”

Section: Telemedicine For Diabetes Managementmentioning

confidence: 99%

The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

Bashshur

Shannon

Smith

et al. 2015

Telemedicine and e-Health

View full text Add to dashboard Cite

Objective: The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. Materials and Methods: A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) Results: Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. Conclusions: Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.

show abstract

Consumer guidelines for chronic disease management

Carson

Labiszewski

Brinn

et al. 2012

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Impact of a chronic care model based on patient empowerment on the management of Type 2 diabetes: effects of the SINERGIA programme

Abstract: The SINERGIA model is effective in improving metabolic control and major cardiovascular risk factors, while allowing diabetologists to dedicate more time to patients with more acute disease.

Cited by 42 publications

References 24 publications

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

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

The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

Consumer guidelines for chronic disease management

Contact Info

Product

Resources

About