The Health Information and Quality Authority (HIQA) has today published a health technology assessment (HTA) with advice to the Health Service Executive (HSE) on the clinical and cost-effectiveness of self-management support interventions for a range of chronic diseases. Chronic diseases are long-term conditions that are managed rather than cured, and which are responsible for a significant proportion of premature deaths and healthcare utilisation. Many of these conditions can be prevented or delayed by reducing key risk factors such as smoking, obesity, excessive alcohol consumption, physical inactivity, hypertension and high cholesterol. Self-management support interventions help patients to manage aspects of their chronic disease through education, training and support.

Self-management support interventions can include different components (for example education, training, provision of information or equipment) and be delivered in different formats such as education and exercise programmes, health coaching, web-based interventions, motivational interviewing, telemedicine, outreach nursing programmes, cardiac rehabilitation and pulmonary rehabilitation.

The specific diseases included in this HTA include asthma, diabetes (Type 1 and Type 2), chronic obstructive pulmonary disease (COPD) and cardiovascular disease (stroke, hypertension, coronary artery disease and heart failure). The health technology assessment also looked at the effectiveness of generic interventions that are not tailored for any specific disease or diseases and could in theory be used in populations with a range of chronic conditions.

The evidence, Health technology assessment of chronic disease self-management support interventions, has been approved by the HIQA Board and presented to the HSE and the Minister for Health.

HIQA’s Director of Health Technology Assessment Dr Máirín Ryan said: “Evidence for the effectiveness of chronic disease support interventions paints a complex picture. Good evidence of clinical effectiveness was found for some disease-specific interventions, leading to improved health and or reduced healthcare utilisation over the short term. However limited or no evidence of effectiveness was found for others, for example generic self management support programmes not tailored to a specific chronic disease.”

HIQA’s health technology assessment advises that the HSE should prioritise investment in those interventions for which there is good evidence of clinical effectiveness.

Dr Ryan continued: “International evidence suggests that most self-management support interventions are relatively inexpensive to implement. However, the budget impact of these interventions could be substantial due to the potentially large number of eligible patients. In some instances, self-management support interventions could lead to modest savings.”

HIQA recommends the development of an agreed definition of chronic disease self-management support interventions and the standardisation of implementation and delivery at a national level. This, together with routine and ongoing evaluation, would ensure that these interventions are delivering benefits to patients.

The HTA reviewed the evidence presented across 159 systematic reviews, incorporating results from over 2,000 randomised controlled trials.

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement, HIQA 01 814 7480 / 086 2447 623 mwhelan@hiqa.ie

Ends.

Notes to the Editor: 

• In December 2014, HIQA received a request from the HSE to conduct an examination into the clinical and cost-effectiveness of both generic self-management support interventions for chronic diseases, and disease-specific interventions for asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease. The health technology assessment (HTA) was requested by the Health Service Executive (HSE) to inform the development of a chronic disease self management support framework for the Irish health service
• An estimated 30% of adults living in Ireland are affected by chronic diseases. The burden of chronic disease is increasing in part due to an aging population, with estimates that the number of adults with chronic diseases will increase to 40% by 2020.
• As regards generic self-management programmes, HIQA found no evidence of improvements in healthcare utilisation. However, some evidence of short-term improvements in patient-reported outcomes of health behaviour, i.e. exercise, health outcomes (pain, depression, fatigue, etc.) and patient-reported outcomes of self-efficacy was found
• Support interventions for patients with asthma can improve quality of life and reduce hospital admissions and the use of urgent and unscheduled healthcare. The optimal support should include education supported by a written asthma action plan as well as improved skills training including the use of inhalers and peak flow meters.
• Education is associated with a reduction in COPD-related hospital admissions, while pulmonary rehabilitation and complex self-management support interventions are associated with improvements in health-care related quality of life. Although the per-patient cost of these interventions is typically low, the overall budget could be considerable due to the high prevalence of COPD in Ireland
• There is very good evidence that patient education can improve blood glucose control in patients with Type 2 diabetes, at least in the short term. Behavioural interventions and telemedicine can result in modest improvements in blood glucose control
• As regards strokes, the best evidence was found for general rehabilitation therapy if delivered in early stroke recovery in terms of positive impact on activities of daily living.
• Exercise-based interventions can reduce mortality and rehospitalisations in selected patients with ischaemic heart disease and can result in some modest cost savings through reductions or shifts in healthcare utilisation
• Regarding hypertension, self-monitoring of blood pressure and other support interventions are beneficial in lowering blood pressure, although the clinical significance and durability of the effect is unclear
• Exercise-based interventions, telehealth and home visit interventions can reduce rehospitalisations in selected patients with heart failure over periods of six to 12 months. Telehealth and home visit interventions may reduce mortality.
• Although there were positive results for some disease-specific self-management support interventions, evidence to support the clinical and cost-effectiveness of others is more limited, or conflicting.