A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program.
A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program.
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DOI：
10.5888/pcd10.120112
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发表时间：
2013
影响因子：
5.5
通讯作者：
Chervin D
中科院分区：
文献类型：
--
作者：
Brady TJ;Murphy L;O'Colmain BJ;Beauchesne D;Daniels B;Greenberg M;House M;Chervin D
慢性病自我管理计划（CDSMP）是一个以社区为基础的自我管理教育计划，旨在帮助参与者获得信心（自我效能）和技能，以更好地管理他们的慢性病;它已在全球范围内实施。本荟萃分析的目的是定量综合在英语国家进行的CDSMP研究的结果，以确定该计划对基线后4至6个月和9至12个月的健康行为，身心健康状况和医疗保健利用的影响。我们检索了8个电子数据库，以识别1999年1月1日至2009年9月30日期间发表的CDSMP相关文献;专家还识别了其他未发表的研究。我们将所有符合条件的研究的结果结合起来计算汇总效应量。共纳入23项研究。18项研究提供了小型英语群体的数据;我们对这些研究进行了1项荟萃分析，并对其他交付模式的结果进行了单独分析。在小型英语组的健康行为中，有氧运动、认知症状管理和与医生的沟通在4- 6个月随访时显著改善;有氧运动和认知症状管理在9 - 12个月时仍显著改善。伸展/强化运动在9至12个月时显著改善。所有心理健康指标在4至6个月和9至12个月时均显著改善。精力，疲劳和自我评价的健康状况在4至6个月时显示出小但显着的改善，但在9至12个月时则没有。医疗保健利用的唯一显著变化是4至6个月时住院天数或夜间数的小幅改善。12个月后心理健康和选定健康行为的小幅至中度改善表明，在小型英语组中提供的CDSMP对参与者产生健康益处，并将成为综合慢性病管理策略的重要组成部分。
The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program’s effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.
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