Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports.

Published

Journal Article (Review)

OBJECTIVE: To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes. DESIGN: Meta-analysis. DATA SOURCES: Computerised databases for English language articles during 1987-2001. STUDY SELECTION: 102 articles evaluating 118 disease management programmes. MAIN OUTCOME MEASURES: Pooled effect sizes calculated with a random effects model. RESULTS: Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (47/118) and provider feedback (32/118). Most programmes (70/118) used more than one intervention. Provider education, feedback, and reminders were associated with significant improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52 (0.35 to 0.69) respectively) and with significant improvements in patient disease control (effect sizes 0.35 (0.19 to 0.51), 0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patient education, reminders, and financial incentives were all associated with improvements in patient disease control (effect sizes 0.24 (0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54) respectively). CONCLUSIONS: All studied interventions were associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.

Full Text

Duke Authors

Cited Authors

  • Weingarten, SR; Henning, JM; Badamgarav, E; Knight, K; Hasselblad, V; Gano, A; Ofman, JJ

Published Date

  • October 26, 2002

Published In

Volume / Issue

  • 325 / 7370

Start / End Page

  • 925 -

PubMed ID

  • 12399340

Pubmed Central ID

  • 12399340

Electronic International Standard Serial Number (EISSN)

  • 1756-1833

Digital Object Identifier (DOI)

  • 10.1136/bmj.325.7370.925

Language

  • eng

Conference Location

  • England