Receiving support for self-management may benefit patients with chronic obstructive pulmonary disorder (COPD) after discharge from hospital, but more evidence is needed

Majothi S, Jolly K, Heneghan NR, et al. Supported self-management for patients with COPD who have recently been discharged from hospital: A systematic review and meta-analysis International Journal of COPD 2015. April:10:853-867

Review question

Are interventions supporting self-management among recently discharged patients with COPD effective at reducing hospital readmission, poor health-related behaviours and mortality?

Background

Patients with COPD have not been benefiting from self-management education, and often suffer complications requiring hospital readmission, which can lead to higher health systems costs and worse patient outcomes.

Some hospitals promote self-management to patients as a part of discharge care, but it is not clear whether it is effective when delivered in this way.

Attempts to improve patient outcomes through tailored self-management support include action plans, education, inhaler techniques, hygiene, stress management, and nutritional programs, although it isn’t clear if these are effective.

How the review was done

A detailed search of a number of electronic databases for studies published up until May 2012 was conducted. Studies that focused on self-management interventions for patients discharged following hospitalization for COPD were included in the review.

A total of 13,559 studies were identified in searches, and 12 were included in the review after assessments for eligibility.

This review was funded by the National Institute for Health Research Health Technology Assessment Programme.

What the researchers found

The review found low-quality studies that suggest self-management support may reduce hospital readmission rates, although there is still uncertainty around this outcome.

The included studies also found that supported self-management improved knowledge about COPD, and patients reported better adherence to medications as well as more appropriate use of inhalers; however, there was limited evidence of effect on health-related behaviours, such as exercise or physical activity.

No evidence was identified on the effectiveness of supported self-management interventions on mortality.

Conclusion

This review found promising but insufficient evidence of the effects of supported self-management on hospital readmission, limited information on behaviour change, and no evidence on reductions in mortality. More evidence is needed to determine if supported self-management interventions for COPD patients after discharge from hospital are effective for improving health outcomes.