Bénéfices des programmes d'éducation thérapeutique dans la BPCO

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A meta-analysis evaluates the benefits of education program for COPD self-management on health and use of care based on the results of 14 clinical trials published between 1985 and 2006.

A Dutch meta-analysis published in 2007 by Effing and colleagues published in the Cochrane Review assessed the efficacy of education programs for self-management of COPD on health indicators and the use of care. Analyzes were based on 14 controlled clinical trials, randomized or not. They showed a decrease of one hospitalization per year for COPD patients participating in an education program compared to those receiving usual care. The results also showed a benefit on quality of life specific to COPD and dyspnea. The authors reported no differences for the number of exacerbations for lung function, physical fitness, for the number of visits to an emergency medical service or the number of working days lost. The meta-analysis did not indicate either differences for doctor visits, for taking corticosteroids, antibiotics and emergency medicines.

The Study Rationale

The Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death worldwide. It causes 2,750,000 deaths in the world. Mortality continues to increase, especially among women. Patients affected by COPD have a progressive disability until they can not move from the bed. Their quality of life deteriorates significantly and irreparably especially because of breathlessness sensation, called dyspnea. This is one of the most costly chronic diseases to health systems.

The issue is whether an education program for self-management of COPD allows patients to adopt more favorable health behaviors to better control symptoms disease, learn to cope better with COPD and reduce the use of routine care and/or emergency. Profits are recognized for asthma, but not yet for COPD, it is the objective of this meta-analysis.

The Question

A therapeutic education program dedicated to self-management of COPD is it effective in improving symptoms and quality of life as in the reduction of direct and indirect costs?

The Protocol

The systematic review contains 14 clinical trials on the topic of the 56 studies reviewed in the scientific and medical literature. The meta-analysis included 2,239 patients diagnosed with COPD. Each non-pharmacological study compared a treatment group composed of patients on a program of education for self-management of COPD to a control group consisting of patients receiving routine care. The duration of educational programs varies from 2 to 6 months. Follow-up measures were ranged from 6 months to 2 years. The results of the meta-analysis concerned COPD symptoms, pulmonary function, physical fitness, health related quality of life, number and severity of exacerbations, antibiotics and steroids taking, the use of unscheduled medicines, hospital admissions, visits to emergency services, attendance at other health facilities and lost workdays.

Main Results

The results show a reduction in hospital admission for exacerbation of COPD (1 hospitalization less per year on average). The results also indicate an improvement in the quality of life specific to COPD as measured by the Saint George Respiratory Questionnaire (SGRQ). The results also show a decrease in the intensity of dyspnea in patients benefiting from the education program for self-management of COPD. By cons, no profit is obtained on other indicators assessed.

What it means for Patients

Follow a COPD-management education program reduces dyspnea, improves quality of life and avoid one hospital admission per year.

What it means for Healthcare Professionals

A COPD-management education program avoids one hospital admission per year, reduces dyspnea and improves health-related quality of life.

What it means for Researchers

The clinical trials used in the current meta-analysis are not homogeneous in terms of variables measured, the characteristics of disease management program, the severity of the disease and how the program was broadcast (written, verbal, visual, auditory). The data available in the literature are still insufficient to formulate clear recommendations on the organization and content of education programs for self-management of COPD. The design of randomized controlled trials should more detail the content of programs.

What it means for Policymakers

A specific COPD management education program avoids one hospitalization per year on average for patients. The generalization of this type of program would undoubtedly make health savings while benefiting patients’ quality of life.

The Reference

Effing TW, Monninkhof EM, van der Valk PDLPM, Zielhuis GA, van Herwaarden CLA, Partridge MR, Walters EH, van der Palen J (2007). Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 4, CD002990.

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To reference this Blog en Sante © article.

Ninot G (2015). The benefits of COPD self-management programs. Blog en Sante, A37.

© Copyright 2015 Grégory Ninot. All rights reserved.