Supporting Self-Management in People with Chronic Conditions: Results from the COMPAR-EU Project

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 30 June 2024 | Viewed by 6675

Special Issue Editor

Special Issue Information

Dear Colleagues,

Continuous progress towards patient-centred care has supported the emergence of a new paradigm in which patients are no longer passive recipients of care but increasingly take an active role in the co-production of their health. This shift has been accompanied by an increasing interest in the best strategies to support self-management, especially for chronic conditions.

Studies suggest self-management support can improve patients’ health outcomes and bring societal value. However, stakeholders lack information about what self-management support activities work best for different patients and contexts.

Effectiveness and cost-effectiveness of self-management interventions in four high-priority chronic conditions in Europe (COMPAR-EU) is an EU-funded project designed to bridge the gap between current knowledge and practice on self-management interventions (SMIs).

In this special issue, a selected group of papers present some of the project's main results regarding patient and stakeholders’ preferences in self-management, comparative effectiveness of interventions and recommendations for implementation.

Dr. Ioannis Ilias
Guest Editor

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Keywords

  • self-management support
  • self-management interventions
  • chronic conditions
  • patient empowerment

Published Papers (5 papers)

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Research

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19 pages, 294 KiB  
Article
COMPAR-EU Recommendations on Self-Management Interventions in Type 2 Diabetes Mellitus
by Jessica Beltran, Claudia Valli, Melixa Medina-Aedo, Carlos Canelo-Aybar, Ena Niño de Guzmán, Yang Song, Carola Orrego, Marta Ballester, Rosa Suñol, Janneke Noordman, Monique Heijmans, Georgios Seitidis, Sofia Tsokani, Katerina-Maria Kontouli, Christos Christogiannis, Dimitris Mavridis, Gimon de Graaf, Oliver Groene, Maria G. Grammatikopoulou, Francisco Camalleres-Guillem, Lilisbeth Perestelo-Perez, Helen McGloin, Kirsty Winkley, Beate Sigrid Mueller, Zuleika Saz-Parkinson, Rosa Corcoy and Pablo Alonso-Coelloadd Show full author list remove Hide full author list
Healthcare 2024, 12(4), 483; https://doi.org/10.3390/healthcare12040483 - 16 Feb 2024
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Abstract
Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of [...] Read more.
Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation. Full article
20 pages, 513 KiB  
Article
Identifying Factors to Facilitate the Implementation of Decision-Making Tools to Promote Self-Management of Chronic Diseases into Routine Healthcare Practice: A Qualitative Study
by Nina Sofie Krah, Paula Zietzsch, Cristina Salrach, Cecilia Alvarez Toro, Marta Ballester, Carola Orrego and Oliver Groene
Healthcare 2023, 11(17), 2397; https://doi.org/10.3390/healthcare11172397 - 25 Aug 2023
Cited by 2 | Viewed by 1070
Abstract
This study, as part of the COMPAR-EU project, utilized a mixed-methods approach involving 37 individual, semi-structured interviews and one focus group with 7 participants to investigate the factors influencing the implementation and use of self-management interventions (SMIs) decision tools in clinical practice. The [...] Read more.
This study, as part of the COMPAR-EU project, utilized a mixed-methods approach involving 37 individual, semi-structured interviews and one focus group with 7 participants to investigate the factors influencing the implementation and use of self-management interventions (SMIs) decision tools in clinical practice. The interviews and focus group discussions were guided by a tailored interview and focus group guideline developed based on the Tailored Implementation for Chronic Diseases (TICD) framework. The data were analyzed using a directed qualitative content analysis, with a deductive coding system based on the TICD framework and an inductive coding process. A rapid analysis technique was employed to summarize and synthesize the findings. The study identified five main dimensions and facilitators for implementation: decision tool factors, individual health professional factors, interaction factors, organizational factors, and social, political, and legal factors. The findings highlight the importance of structured implementation through SMI decision support tools, emphasizing the need to understand their benefits, secure organizational resources, and gain political support for sustainable implementation. Overall, this study employed a systematic approach, combining qualitative methods and comprehensive analysis, to gain insights into the factors influencing the implementation of SMIs’ decision-support tools in clinical practice. Full article
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Review

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21 pages, 2269 KiB  
Review
Self-Management Interventions for Adults Living with Type II Diabetes to Improve Patient-Important Outcomes: An Evidence Map
by Yang Song, Jessica Beltran Puerta, Melixa Medina-Aedo, Carlos Canelo-Aybar, Claudia Valli, Marta Ballester, Claudio Rocha, Montserrat León Garcia, Karla Salas-Gama, Chrysoula Kaloteraki, Marilina Santero, Ena Niño de Guzmán, Cristina Spoiala, Pema Gurung, Fabienne Willemen, Iza Cools, Julia Bleeker, Rune Poortvliet, Tajda Laure, Marieke van der Gaag, Kevin Pacheco-Barrios, Jessica Zafra-Tanaka, Dimitris Mavridis, Areti Angeliki Veroniki, Stella Zevgiti, Georgios Seitidis, Pablo Alonso-Coello, Oliver Groene, Ana Isabel González-González, Rosa Sunol, Carola Orrego and Monique Heijmansadd Show full author list remove Hide full author list
Healthcare 2023, 11(24), 3156; https://doi.org/10.3390/healthcare11243156 - 13 Dec 2023
Cited by 1 | Viewed by 1998
Abstract
Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention [...] Read more.
Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10–14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56%), goal-setting (48%) and skills training (42%) to improve outcomes. Management of emotions (17%) and shared decision-making (5%) were almost never mentioned. Although diabetes is highly prevalent in some minority groups, in only 13% of the SMIs, these groups were included. Our findings highlight the large heterogeneity that exists in the design of SMIs for T2DM and the way studies are reported, making accurate comparisons of their relative effectiveness challenging. In addition, SMIs pay limited attention to outcomes other than clinical, despite the importance attached to these outcomes by patients. More standardized and streamlined research is needed to better understand the effectiveness and cost-effectiveness of SMIs of T2DM and benefit patient care. Full article
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Other

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14 pages, 1657 KiB  
Systematic Review
Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials
by Marilina Santero, Yang Song, Jessica Beltran, Melixa Medina-Aedo, Carlos Canelo-Aybar, Claudia Valli, Claudio Rocha, Montserrat León-García, Karla Salas-Gama, Chrysoula Kaloteraki, Ena Niño de Guzmán, Marta Ballester, Ana Isabel González-González, Rune Poortvliet, Marieke van der Gaag, Cristina Spoiala, Pema Gurung, Fabienne Willemen, Iza Cools, Julia Bleeker, Angelina Kancheva, Julia Ertl, Tajda Laure, Ivana Kancheva, Kevin Pacheco-Barrios, Jessica Hanae Zafra-Tanaka, Sofia Tsokani, Areti Angeliki Veroniki, Georgios Seitidis, Christos Christogiannis, Katerina Maria Kontouli, Oliver Groene, Rosa Sunol, Carola Orrego, Monique Heijmans and Pablo Alonso-Coelloadd Show full author list remove Hide full author list
Healthcare 2024, 12(3), 302; https://doi.org/10.3390/healthcare12030302 - 24 Jan 2024
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Abstract
Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted [...] Read more.
Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF. Full article
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21 pages, 9496 KiB  
Systematic Review
Exploring the Effectiveness of Self-Management Interventions in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis
by Sofia Tsokani, Georgios Seitidis, Christos Christogiannis, Katerina-Maria Kontouli, Stavros Nikolakopoulos, Stella Zevgiti, Carola Orrego, Marta Ballester, Rosa Suñol, Monique Heijmans, Rune Poortvliet, Marieke van der Gaag, Pablo Alonso-Coello, Carlos Canelo-Aybar, Jessica Beltran, Ana I. González-González, Gimon de Graaf, Areti-Angeliki Veroniki and Dimitrios Mavridis
Healthcare 2024, 12(1), 27; https://doi.org/10.3390/healthcare12010027 - 22 Dec 2023
Cited by 1 | Viewed by 1213
Abstract
Background: Chronic diseases are a leading cause of global morbidity and mortality. In response to this challenge, self-management interventions (SMIs) have emerged as an essential tool in improving patient outcomes. However, the diverse and complex nature of SMIs pose significant challenges in measuring [...] Read more.
Background: Chronic diseases are a leading cause of global morbidity and mortality. In response to this challenge, self-management interventions (SMIs) have emerged as an essential tool in improving patient outcomes. However, the diverse and complex nature of SMIs pose significant challenges in measuring their effectiveness. This work aims to investigate the comparative effectiveness of SMIs on Type 2 diabetes mellitus (T2DM) outcomes. Methods: A rigorous analytical framework was employed to assess the relative effectiveness of different SMIs, encompassing both pairwise and network meta-analysis (NMA), as well as component network meta-analysis (CNMA). Various outcomes were considered, including glycated hemoglobin (HbA1c) control, body mass index (BMI) reduction and low-density lipoprotein (LDL) cholesterol. Visualization tools were also utilized to enhance the interpretation of results. Results: SMIs were found promising in improving clinical outcomes and patient-reported measures. However, considerable heterogeneity and inconsistency across studies challenged the validity of NMA results. CNMA along with various visualization tools offered insights into the contributions of individual SMI components, highlighting the complexity of these interventions. Discussion/Conclusions: SMIs represent a valuable approach to managing chronic conditions, but their effectiveness is context-dependent. Further research is needed to elucidate the contextual factors influencing SMI outcomes. This work contributes to a comprehensive understanding of SMIs’ role in T2DM management, aiming to aid decision-makers, clinicians, and patients in selecting tailored interventions. Full article
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