RESUMO
OBJECTIVE: To evaluate the effectiveness of interventions aimed at improving the quality and outcome of chronic disease management. METHODS: Systematic review of the literature. INCLUSION CRITERIA: Clinical trials in English and Spanish that assess the effectiveness of 1 or more strategies for improving quality and outcome in asthma, diabetes, hypertension, and congestive heart failure. Interventions were classified in line with a conceptual model in 6 categories: organizational changes, community participation, information systems, clinical practice design, decision-making support, and self-management. The outcomes considered were: health service utilization, chronic disease management, clinical outcomes, quality of life, satisfaction, and self-management indicators. RESULTS: Thirty seven studies with 38 interventions were included. The most common interventions were those that investigated changes in health care design, followed by those analysing information systems and decision-making support. The most complex interventions, in terms of the overall number of strategies, including support for self-management, showed more likelihood of positive effects in clinical management and clinical outcomes. Few interventions achieved improvements in use of health care services, though patients perceived substantial improvements. CONCLUSIONS: In order to improve quality and effectiveness of chronic disease management, it is necessary to take a systematic view including proactive health care systems and patients taking an active role in managing their disease. These programmes should combine, at the least, organizational strategies, design of clinical practice and patient self-management.
Assuntos
Doença Crônica/terapia , Humanos , Qualidade da Assistência à Saúde/normasRESUMO
Objetivo. Investigar la efectividad de diferentes estrategias destinadas a mejorar la calidad y los resultados de las intervenciones en el tratamiento de las enfermedades crónicas. Metodología. Revisión sistemática de la bibliografía. Criterios de inclusión. Ensayos clínicos en lengua inglesa o española que evalúen la efectividad de distintas intervenciones para mejorar los resultados asistenciales del asma, la diabetes, la hipertensión y la insuficiencia cardíaca. Las intervenciones se clasifican de acuerdo con un modelo conceptual en 6 categorías: cambios organizativos, participación comunitaria, sistemas de información, diseño de la práctica clínica, apoyo a la toma de decisiones y de autocontrol. Los resultados evaluados fueron: utilización de servicios de salud, tratamiento clínico, resultados clínicos, calidad de vida, satisfacción e indicadores de capacidad de autocontrol. Resultados. Se incluyeron 37 estudios que incorporaban 38 intervenciones. Las intervenciones más frecuentes son las que investigan los cambios en el de diseño asistencial, seguidas de las que analizan el efecto de los sistemas de información y apoyo a la toma de decisiones. Las intervenciones más complejas en número de intervenciones, incluido el apoyo para el autocontrol, mostraron una mayor probabilidad de tener efectos positivos en el tratamiento y en los resultados clínicos. Pocas intervenciones consiguen mejoras en utilización de servicios, aunque sí se observaron sustanciales mejoras en los resultados percibidos. Conclusiones. Para mejorar la calidad asistencial y la efectividad en el control de las enfermedades crónicas es preciso adoptar una visión sistemática que incluya un sistema sanitario proactivo y pacientes protagonistas activos del tratamiento de su enfermedad. Los programas así diseñados deben combinar, al menos, estrategias organizativas, de diseño asistencial y de autocontrol
Objective. To evaluate the effectiveness of interventions aimed at improving the quality and outcome of chronic disease management. Methods. Systematic review of the literature. Inclusion criteria. Clinical trials in English and Spanish that assess the effectiveness of 1 or more strategies for improving quality and outcome in asthma, diabetes, hypertension, and congestive heart failure. Interventions were classified in line with a conceptual model in 6 categories: organizational changes, community participation, information systems, clinical practice design, decision-making support, and self-management. The outcomes considered were: health service utilization, chronic disease management, clinical outcomes, quality of life, satisfaction, and self-management indicators. Results. Thirty seven studies with 38 interventions were included. The most common interventions were those that investigated changes in health care design, followed by those analysing information systems and decision-making support. The most complex interventions, in terms of the overall number of strategies, including support for self-management, showed more likelihood of positive effects in clinical management and clinical outcomes. Few interventions achieved improvements in use of health care services, though patients perceived substantial improvements. Conclusions. In order to improve quality and effectiveness of chronic disease management, it is necessary to take a systematic view including proactive health care systems and patients taking an active role in managing their disease. These programmes should combine, at the least, organizational strategies, design of clinical practice and patient self-management
