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Review ArticleReview Article

Adult Asthma Disease Management: An Analysis of Studies, Approaches, Outcomes, and Methods

Matthew L Maciejewski, Shih-Yin Chen and David H Au
Respiratory Care July 2009, 54 (7) 878-886;
Matthew L Maciejewski
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; the Department of Medicine, Duke University Medical Center, Durham North Carolina; and the Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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  • For correspondence: [email protected]
Shih-Yin Chen
Abt Bio-Pharma Solutions, Lexington, Massachusetts.
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David H Au
Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle Washington, and with the Department of Medicine, University of Washington Medical Center, Seattle Washington.
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Abstract

BACKGROUND: Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published studies.

METHODS: We searched the MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane databases for studies published in 1986 through 2008, on adult asthma management. With the studies that met our inclusion criteria, we examined the clinical, process, medication, economic, and patient-reported outcomes reported, and the study designs, provider collaboration during the studies, and statistical methods.

RESULTS: Twenty-nine articles describing 27 studies satisfied our inclusion criteria. There was great variation in the content, extent of collaboration between physician and non-physician providers responsible for intervention delivery, and outcomes examined across the 27 studies. Because of limitations in the design of 22 of the 27 studies, the differences in outcomes assessed, and the lack of rigorous statistical adjustment, we could not draw definitive conclusions about the effectiveness or cost-effectiveness of the asthma disease-management programs or which approach was most effective.

CONCLUSIONS: Few well-designed studies with rigorous evaluations have been conducted to evaluate disease-management interventions for adults with asthma. Current evidence is insufficient to recommend any particular intervention.

  • asthma
  • disease management
  • outcomes
  • study design
  • study quality

Footnotes

  • Correspondence: Matthew L Maciejewski PhD, Center for Health Services Research in Primary Care, Legacy Tower, 411 West Chapel Hill Street, Durham NC 27701. E-mail: mlm34{at}duke.edu.
  • Copyright © 2009 by Daedalus Enterprises Inc.
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Respiratory Care: 54 (7)
Respiratory Care
Vol. 54, Issue 7
1 Jul 2009
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Adult Asthma Disease Management: An Analysis of Studies, Approaches, Outcomes, and Methods
Matthew L Maciejewski, Shih-Yin Chen, David H Au
Respiratory Care Jul 2009, 54 (7) 878-886;

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Adult Asthma Disease Management: An Analysis of Studies, Approaches, Outcomes, and Methods
Matthew L Maciejewski, Shih-Yin Chen, David H Au
Respiratory Care Jul 2009, 54 (7) 878-886;
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Keywords

  • asthma
  • disease management
  • outcomes
  • study design
  • study quality

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