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Intervention

Consumer Intervention: Acquiring skills and competencies

Definition

Strategies focusing on the acquisition of skills relevant to medicines use. Interventions aim to assist consumers to develop a broad set of competencies around medicines use and health, such as medicines management or monitoring; or training consumers in the correct use of treatments or devices to deliver treatment.

Effectiveness

There is some evidence that strategies which focus on the acquisition of skills and competencies may improve adherence, medicines use and clinical outcomes, but results are mixed. Regarding specific types of interventions, there is sufficient evidence that self-management skills for oral anticoagulation therapy decrease adverse events such as thromboembolic events, mortality and minor haemorrhages but not major haemorrhages. Conversely, there was sufficient evidence that self-monitoring decreases major haemorrhages but not thromboembolic events, mortality and minor haemorrhages. There is some evidence that pharmacy discharge planning decreases medicines errors, adherence and knowledge — results are mixed. There is some evidence that patient-controlled analgesia (PCA) for post-operative pain relief is effective in increasing analgesic consumption and may decrease pain levels, but effects on other clinical outcomes and adverse effects are mixed. There is some evidence that disease-specific interventions to support skills acquisition in relation to medicines use, such as those for HAART, diabetes, asthma, COPD, glaucoma and epilepsy medicines management may be effective, but effects on specific outcomes including adherence, medicines use and clinical outcomes are mixed. There is some evidence that decision aids improve skills in making decisions by reducing decisional conflict along with other decision-making process outcomes.

The evidence is otherwise inconclusive due to a lack of trials for the effectiveness of interventions to improve cystic fibrosis self-management or parenting training strategies for intellectually disabled parents on medicines use related and other outcomes.

Summary of Overall Findings from Reviews

Summary of Findings Related to Prescribing

31 reviews focusing on the acquisition of skills relevant to medicines use were identified; 20 were of high quality.

One key review of self-monitoring and self-management skills for oral anticoagulation therapy (Garcia-Alamino 2010) demonstrated that self-management significantly decreased thromboembolic events, mortality, and minor but not major haemorrhages, while self-monitoring significantly decreased major haemorrhages but not thromboembolic events, mortality and minor haemorrhages. Both self-monitoring and self-management skills had mixed effects on clinical outcomes; however a significant proportion of people undertaking these strategies were unable to complete treatment, suggesting that self-monitoring and self—management may not be appropriate for everyone undertaking oral anticoagulation therapy.

One other review on support and education for highly active antiretroviral therapy (HAART) showed improved adherence in the majority of studies together with mixed effects on clinical outcomes overall (Rueda 2006), but interventions incorporating practical medicines management skills were most consistently effective.

Other disease-specific reviews reported mixed effects for adherence, medicines use and clinical outcomes, including education or self-management education for diabetes (Deakin 2005, Vermeire 2005) or cystic fibrosis (Savage 2011) and action plans or self-management education for asthma or COPD (Bhoghal 2006, Boyd 2009, Powell 2002, Turnock 2005).

Another self-monitoring review (Bainbridge 2006) comparing patient-controlled (PCA) with nurse-controlled post-operative analgesia reported increased analgesic consumption and improved longer term (48 hr) pain control with PCA, but few effects on other clinical outcomes, adverse effects or discontinuation.

One further review (Gray 2009) on education and care planning, reminder devices and different simplified dose regimens for topical eye drop treatments in glaucoma reported mixed effects on medicines use and adherence, missed doses and clinical outcomes. Pharmacy discharge plans decreased medicines errors but had mixed effects on medicines adherence and knowledge (Shepperd 2010). A review of individual parenting training for intellectually disabled parents reported increased recognition of a life threatening emergency but no effects on medicines related knowledge and comprehension (Coren 2011).

Some reviews reported positive effects of skills acquisition strategies on knowledge (Deakin 2005, Turnock 2005); however, improved knowledge co-occurred with mixed effects on clinical outcomes and did not translate into consistent improvements in self-management behaviours or adherence (Bradley 2008, Tapp 2007, Savage 2011). Decision making skills and their impact on outcomes such as decisional conflict have been improved through use of decision aids (Stacey 2011).

Reviews listed as "Summary Pending" will be analyzed, summarized and reported at a later date.

The findings will then be incorporated in the overall evidence summaries of the interventions they address.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Bhogal S, Zemek R, Ducharme FM. Written action plans for asthma in children. Cochrane Database of Systematic Reviews 2006 3:CD005306. 11 (High)
Garcia-Alamino J, Ward A, Alonso-Coello P, Perera R, Bankhead C, Fitzmaurice D, Heneghan C. Self-monitoring and self-management of oral anticoagulation. Cochrane Database of Systematic Reviews 2010 4:CD003839. 11 (High)
Welsh EJ, Hasan M, Li P. Home-based educational interventions for children with asthma. Cochrane Database of Systematic Reviews 2011 10:CD008469. 11 (High)
Boyd M, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M. Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database of Systematic Reviews 2009 2:CD001290. 10 (High)
Gray TA, Orton LC, Henson D, Harper R, Waterman H. Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database of Systematic Reviews 2009 2:CD006132. 10 (High)
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008 2:CD000011. 10 (High)
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Legare F, Thomson R. Decision aids for people facing health treatment or screening decisions (update). Cochrane Database of Systematic Reviews 2011 10:CD001431. 10 (High)
Vermeire E, Wens J, Van RP, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005 2:CD003638. 10 (High)
Bainbridge D, Martin JE, Cheng DC. Patient-controlled versus nurse-controlled analgesia after cardiac surgery--a meta-analysis. Canadian Journal of Anaesthesia 2006 53 (5):492-9. 9 (High)
Bradley PM, Lindsay B. Care delivery and self-management strategies for adults with epilepsy. Cochrane Database of Systematic Reviews 2008 1:CD006244. 9 (High)
Clar C, Waugh N, Thomas S. Routine hospital admission versus out-patient or home care in children at diagnosis of type 1 diabetes mellitus. Cochrane Database of Systematic Reviews 2007 2:CD004099. 9 (High)
Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005 2:CD003417. 9 (High)
Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database of Systematic Reviews 2003 1:CD004107. 9 (High)
Rueda S, Park-Wyllie LY, Bayoumi AM, Tynan AM, Antoniou TA, Rourke SB, Glazier RH. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database of Systematic Reviews 2006 3:CD001442. 9 (High)
Savage E, Beirne PV, Ni Chroinin M, Duff A, Fitzgerald T, Farrell D. Self-management education for cystic fibrosis. Cochrane Database of Systematic Reviews 2011 7:CD007641. 9 (High)
Shepperd S, McClaran J, Phillips C, Lannin N, Clemson L, McCluskey A, Cameron I, Barras S. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2010 1:CD000313. 9 (High)
Tapp S, Lasserson TJ, Rowe B. Education interventions for adults who attend the emergency room for acute asthma. Cochrane Database of Systematic Reviews 2007 3:CD003000. 9 (High)
Coren E, Hutchfield J, Thomae M, Gustafsson C. Parent training support for intellectually disabled parents. Cochrane Database of Systematic Reviews 2010 6:CD007987. 8 (High)
Jones A, Fay JK, Ram FSF. Primary care based clinics for asthma. Cochrane Database of Systematic Reviews 2002 1:CD003533. 8 (High)
Turnock AC, Walters EH, Walters JA, Wood-Baker R. Action plans for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005 4:CD005074. 8 (High)
Bailey EJ, Cates CJ, Kruske SG, Morris PS, Chang AB, Brown N. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database of Systematic Reviews 2009 1:CD006580. 7 (Medium)
Bennett M, Bagnall A, Jose CS. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 2009 143 (3):192-9. 7 (Medium)
Effing T, Monninkhof EM, van der Valk PD, van der Palen J, van Herwaarden CL, Partidge MR, Walters EH, Zielhuis GA. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2007 4:CD002990. 7 (Medium)
Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH. Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews 2003 1:CD001117. 7 (Medium)
Roughead EE, Semple SJ, Vitry AI. Pharmaceutical care services: A systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes. International Journal of Pharmacy Practice 2005 13 (1):53-70. 7 (Medium)
Agarwal R, Bills JE, Hecht TJW, Light RP. Role of Home Blood Pressure Monitoring in Overcoming Therapeutic Inertia and Improving Hypertension Control. Hypertension 2011 57:29-38. 6 (Medium)
Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharmacy World & Science 2006 28 (3):140-51. 5 (Medium)
Yankova Z. Patients' knowledge of patient controlled analgesia (PCA) and their experience of postoperative pain relief: a review of the impact of structured preoperative education. Journal of Advanced Perioperative Care 2008 3 (3):91-9. 5 (Medium)
Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. Journal of Acquired Immune Deficiency Syndromes 2006 41 (3):285-97. 4 (Medium)
Morrison A, Wertheimer AI. Evaluation of studies investigating the effectiveness of pharmacists' clinical services. American Journal of Health-System Pharmacy 2001 58 (7):569-77. 4 (Medium)
Russell CL, Conn VS, Jantarakupt P. Older adult medication compliance: integrated review of randomized controlled trials. American Journal of Health Behavior 2006 30 (6):636-50. 4 (Medium)
Boyers D, McNamee P, Clarke A, Jones D, Martin D, Schofield P, Smith BH. Cost-effectiveness of self-management methods for the treatment of chronic pain in an aging adult population: a systematic review of the literature. Clinical Journal of Pain 2013 29 (4):366-375. Summary Pending
Catalani C, Philbrick W, Fraser H, Mechael P, Israelski DM. mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature. The open AIDS journal 2013 7:17-41. Summary Pending
Coleman CI, Limone B, Sobieraj DM, Lee S, Roberts MS, Kaur R, Alam T. Dosing frequency and medication adherence in chronic disease. Journal of Managed Care Pharmacy 2012 18 (7):527-539. Summary Pending
Coleman CI, Roberts MS, Sobieraj DM, Lee S, Alam T, Kaur R. Effect of dosing frequency on chronic cardiovascular disease medication adherence. Current Medical Research & Opinion 2012 28 (5):669-680. Summary Pending
de JT, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database of Systematic Reviews 2012 12:CD007459. Summary Pending
El-Gayar O, Timsina P, Nawar N, Eid W. A systematic review of IT for diabetes self-management: are we there yet? International Journal of Medical Informatics 2013 82 (8):637-652. Summary Pending
Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Medicine / Public Library of Science 2013 10 (1):e1001362. Summary Pending
Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database of Systematic Reviews 2013 11:CD010013. Summary Pending
McIntosh B, Yu C, Lal A, Chelak K, Cameron C, Singh SR, Dahl M. Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Medicine : A Peer-reviewed, Independent, Open-access Journal 2010 4 (2):e102-113. Summary Pending
Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, Sriram PS, Zagora J. Web 2.0 chronic disease self-management for older adults: a systematic review. Journal of Medical Internet Research 2013 15 (2):e35. Summary Pending
van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients--a systematic review. Maturitas 2012 73 (2):94-114. Summary Pending