Authors' objectives:

Chronic diseases represent one of the major challenges facing health care services. The main objective of this review is to evaluate the effectiveness of interventions aimed to improve the quality and outcomes in managing chronic diseases considering the scientific evidence available.

Authors' results and conclusions: A total of 37 studies with 38 interventions were identified for inclusion in this review. The main limitation of this review is the quality and quantity of the works assessed. The interventions more frequently assessed were those with diabetes patients and those that investigated the effects of designing health care services, followed by information systems and decision making support. The most frequent number of strategies analyzed in a single intervention were two. Outcomes more frequently assessed were those indicators associated with management of chronic patients, primary care visits and clinical outcomes. Clinical management of chronic patients were also the indicators that showed a higher probability of success, followed by self-control measures. Interventions that included organizational changes or designing clinical care were those that achieved better outcomes, specially regarding clinical management. More complex interventions, in terms of the overall number of strategies included, showed a consistent pattern of higher probability of achieving better outcomes in terms of clinical management and clinical outcomes. Most of the interventions that evaluated health care services were not successful. Patient perceived outcomes were the less frequent assessed although in many cases had a positive outcome.

Authors' recommendations: Interventions that achieve positive outcomes in managing chronic diseases and self-management, also achieve positive clinical outcomes. Organization strategies show favorable outcomes in terms of health services utilization (hospitalizations and primary care). Simpler interventions, in terms of number of strategies, have a lower probability of having success. All strategies considered have positive effects on clinical management. Clinical management occurs with a combination of al least two strategies. Health care design appears as the necessary strategy to achieve clinical outcomes, but it needs a combination of two other strategies. Combining self-management strategies, with information systems or design offers positive outcomes in self-control. In order to improve quality and effectiveness of chronic disease management, interventions should combine organizational changes, designing of clinical practice and patient self-management. In order to achieve clinical changes both improving clinical management and patient self-management is necessary. Effective chronic diseases care require proactive health care systems and patients taking an active role in managing their disease.

Authors' methods: REview

Project Status: Completed

URL for project: http://www.isciii.es/aets/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias (AETS)