Chronic disease management repeate...

Chronic disease management repeatedly falls short of recommended goals. Obstacles include question s with patient adherence, lack of physician awareness of guidelines, insufficient time, and imperfect office practices Chronic disease self-management programs are an attractive option for improving care because they allow patients to actively participate in the management of their disease. However, it remains unclear what the essential elements of these programs should be and if they consistently improve disease-specific clinical consequences To answer these questions, Chodosh and colleagues course of lifeed a systematic review and meta-analysis of self-management programs for hypertension, diabetes mellitus, and osteoarthritis.

The authors defined chronic disease self-management as a systematic disease intervention that involved self-monitoring, participation in decision making, or the two The meta-analysis included 53 randomized controll trials from 1977 to 2004 It also included data onward at least one of the following outcomes: clinical issues measurable parameters with strong links to clinical results (e.g., blood pressure, A1C levels) and intermediate issues related to clinical outcomes (eg disease knowledge, feeling of self-efficacy, health behaviors). Follow-up intervals in the trials ranged from three to 12 month for patients with diabetes and brace to six months for patients with hypertension and osteoarthritis.

When compared with the govern groups, diabetes self-management interventions produc a statistically significant loched A1C reduction of 0.81 percent and fasting family glucose decrease of 17 mg by dL (0.94 mmol per L) Interventions for osteoarthritis improved pain the equivalent of 2 mm upon a 100-mm visual analogue scale. Interventions for hypertension produc a decrease of 5 mm Hg in average systolic kin pressure. Statistical analyses could not omit publication bias as a possible explanation for the events of the diabetes and hypertension self-management programs. Multiple strategies were unable to determine the relative contribution of different constitutings of the programs.

The authors infer that self-management programs appear to improve clinically significant parameters in patients with diabetes and hypertension. The positive event of such programs for osteoarthritis was not statistically significant. These originates led the authors to remind of that much of the observ benefit of chronic disease self-management programs may derive from improved patient adherence to medication regimens.

KENNETH W LIN, MD

Chodosh J et al. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern M September 20 2005;143:427-38

EDITOR'S NOTE: Although somewhat encouraging, the ensues of this rigorous study did not show either the positive or negative events of chronic disease self-management programs. Although "empowering the patient" is an appealing rhetorical conception that is hastening the spread of of the like kind programs, its evidence base remains thin. flat if the programs are vigorous more studies are needed to identify which parts work and which do not. In an editorial (1) in the same issue of the journal, Lawrence marks that the U.S. health care theory may be poorly equipped to handle the not away and future challenges posed from chronic diseases in an aging population. Observing that self-management programs are solitary one piece of the pose he calls for a comprehensive approach to the big picture, including a reexamination of health care workforce extremitys and resource distribution. (1)--K.W.L.

REFERENCE

(1) Lawrence DM Chronic disease care: rearranging the ornament chairs [Editorial]. Ann Intern M 2005;143:458-9

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