Melbourne EpiCentre, The University of Melbourne and Melbourne Health, Parkville, Victoria 3050, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Melbourne EpiCentre, The University of Melbourne and Melbourne Health, Parkville, Victoria 3050, Australia.
Best Pract Res Clin Rheumatol. 2014 Feb;28(1):119-42. doi: 10.1016/j.berh.2014.01.011.
Chronic disease management (CDM) service models are being developed for many conditions; however, there is limited evidence to support their effectiveness in osteoarthritis (OA). A systematic review was undertaken to examine effectiveness, cost effectiveness and barriers to the use of osteoarthritis-chronic disease management (OA-CDM) service models. Thirteen eligible studies (eight randomised controlled trial (RCTs)) were identified. The majority focussed on delivery system design (n = 9) and/or providing self-management support (SMS) (n = 8). Overall, reported model effectiveness varied, and where positive impacts on process or health outcomes were observed, they were of small to moderate effect. There was no information about cost effectiveness. There is some evidence to support the use of collaborative care/multidisciplinary case management models in primary and community care and evidence-based pathways/standardisation of care in hospital settings. Multiple barriers were identified. Future research should focus on identifying the effective components of multi-faceted interventions and evaluating cost-effectiveness to support clinical and policy decision-making.
正在为许多疾病开发慢性病管理 (CDM) 服务模式；然而，关于骨关节炎 (OA) 的 CDM 服务模式的有效性的证据有限。进行了系统评价，以检查骨关节炎慢性病管理 (OA-CDM) 服务模式的有效性、成本效益和使用障碍。确定了 13 项符合条件的研究（8 项随机对照试验 (RCT)）。大多数研究侧重于交付系统设计（n=9）和/或提供自我管理支持 (SMS)（n=8）。总体而言，报告的模型效果各不相同，并且在观察到对过程或健康结果有积极影响的情况下，其效果也较小到中等。没有关于成本效益的信息。有一些证据支持在初级和社区护理中使用协作护理/多学科病例管理模式，以及在医院环境中使用循证途径/护理标准化。确定了多个障碍。未来的研究应侧重于确定多方面干预措施的有效组成部分，并评估成本效益，以支持临床和政策决策。
