Self-management interventions for patients with a chronic disease: what works and in whom?

Abstract

Self-management interventions for patients with a chronic disease are considered an essential part of care for those patients. Studies evaluating the effectiveness of this type of interventions have shown heterogeneous results. This leaves healthcare professionals oblivious with regard to implementation of self-management strategies in practice. This thesis aimed to identify which subgroups of patients benefit from self-management interventions and what type of intervention works best. An individual patient data (IPD) meta-analysis was conducted in which the raw data of prior trials in this field of research were requested and merged in one large database. To investigate if observed effects were disease-specific or transcend the specific disease, this IPD meta-analysis was performed parallel in patients with heart failure (n=5624) and patients with COPD (n=3282). First, overall effects were estimated. Self-management interventions were particularly effective in improving outcomes directly related to the disease. There was a small improvement in disease-related quality of life and reduction of disease-related hospitalization or death in both patients groups. The analyses further showed that self-management interventions reduced time to death in heart failure patients with depressive symptoms. In COPD patients, better outcomes were observed for males, patients with more severe airflow obstruction, obesity, and patients with moderate self-efficacy, but results were inconsistent across outcomes. The data were also used to identify characteristics of effective self-management interventions. This analysis revealed that interventions with a longer duration (in months) could lead to better health outcomes in patients with heart failure and patients with COPD.