NIHR Imperial Patient Safety Translational Research Centre (PSTRC), Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK.
Patient Educ Couns. 2021 Jan;104(1):50-63. doi: 10.1016/j.pec.2020.08.015. Epub 2020 Sep 2.
The study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.
A systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).
A total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.
This review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.
Practices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.
本研究旨在评估自我管理方案改变慢性阻塞性肺疾病（COPD）患者就医行为的能力，以及方案设计与结果之间的任何关联。
系统检索文献，返回了 COPD 的自我管理方案的随机对照试验。主要结局测量是医疗保健利用的变化。使用理论领域框架（TDF）分析方案设计。
共有 26 篇论文描述了 19 项自我管理方案。最常见的利用结局是住院治疗（n=22）。其中，有 5 项显示出显著减少。所有方案都证明了至少 5 个领域的存在：技能和行为调节。然而，TDF 领域与利用之间没有明确的关联。总体而言，研究质量为中等至较差。
本综述强调了自我管理方案在目标、设计和评估方面需要更加一致。具体而言，TDF 可用于指导未来方案的设计和评估。
实践有合理的期望，即他们采用的干预措施将为患者提供效益和物有所值。更好地设计和报告自我管理方案试验将解决它们是否能够做到这一点的问题。
