| ObjectiveTo evaluate the effects of transitional care on chronic obstructive pulmonary disease (COPD) patients’utilization of health resources, quality of life, exercise capacity, dyspnea, lung function, anxiety ,depression and self-efficacy using Cochrane systematic review and, if possible, all time-points meta-analysis of repeated measures (ATM) was performed for data synthesis.MethodsWe searched the Cochrane Central Register of Controlled Trials(-2015.4), Medline(1980～2015.4), Embase(1974～2015.4), AMED(1985～2015.4), CINAHL(～2015.4), CMB, CNKI, VIP and wanfang to collect all of the randomized controlled Trials(RCTs) or quasi-randomized control trials (quasi-RCTs) in which transitional care intervention was used with COPD.The studies were selected according to the inclusion and exclusion criteria by two reviewers, and the quality of included studies was evaluated according to Cochrane Handbook and performed Meta-analysis by using The Cochrane Collaboration’s RevMan 5.3 software.ResultsForty-one RCTs and three quasi-RCTs involving 4811 patients were included.Results of the evaluation showed the bias risk of the 44 studies were unclear. Among the 44 studies, adverse events were reported in 2 studies, including fractures and exacerbations, and no other adverse events were reported.Results of meta analysis were listed as follows:1. Health resources utilization:18 studies reported health resources utilization, considering the health resource utilization is affected by the domestic and foreign medical insurance system, so the health resource utilization was divided into domestic and foreign data analysis. In China: ①Hospitalization:at 6 months, Mean difference(MD)=-0.33,95% confidence interval (95%CI) (-0.47,-0.18), P<0.05;②Re-admission:at 6 months, MD= -0.67, 95%CI (-1.34, 0.01), P = 0.05.Abroad:①Admission: at 3 months,MD= -0.13, 95%CI (-0.15, -0.11), P<0.05;②Emergency: at 3 months, MD= -0.02, 95%CI (-0.44,-0.01), P<0.05; at 12 months, MD= -0.36, 95%CI (-0.62, -0.10), P<0.05; ③ Re-admission: at 12 months, MD= -0.27, 95%CI (-0.56, 0.01), P>0.05; ④Length of stay: at 12 months, MD= -1.30, 95%CI (-5.01,2.40), P>0.05.2. Quality of life(QOL): 15 studies reported QOL.①Symptoms subscale: at 3 months, MD= -14.89, 95%CI (-26.09, -3.69) , P<0.05; at 4 months, MD= -5.56, 95%CI (-8.89,-2.22), P<0.05;at 6 months, MD= -5.15, 95%CI (-7.13, -3.17) , P<0.05; ②Activity subscale: at 3 months, MD= -15.01, 95%CI (-23.98, -6.04), P<0.05;at 4 months, MD=-9.11, 95%CI (-12.61, -5.62), P<0.05;at 6 months, MD= -5.95, 95%CI (-7.81,-4.10) , P< 0.05; ③Impact subscale: at 3 months, MD= -17.32, 95%CI (-26.46, -8.18), P<0.05; at 4 months, MD= -11.27, 95%CI (-13.89, -8.65), P<0.05; at 6 months, MD= -8.13, 95%CI (-13.31, -2.96), P<0.05;?Total score: at 1 month, MD= -5.78, 95%CI(-15.16, 3.59), P> 0.05; at 3 months, MD= -16.66, 95%CI (-23.16, -10.17), P<0.05; at 4 months, MD=-10.48, 95%CI (-13.75, -7.20), P<0.05; at 6 months, MD= -10.41, 95%CI (-13.90, -6.91), P<0.05;3. Dyspnea : 4 studies reported dyspnea .at 1 month, MD = -0.73 , 95%CI (-1.56, 0.10), P>0.05; at 2 months, MD=-0.26 , 95%CI (-0.79,0.2/), P>0.05; at 3 months, MD =-1.11 , 95%CI (-1.31,-0.91), P<0.05;at 6 months, MD =-1.31 , 95%CI (-1.70,0.92)), P <0.05;at 12 months, MD = -1.64, 95%CI(-1.87, -1.40), P<0.05.4. Exercise capacity: 8 studies reported exercise capacity, at 3 months, MD = 50.06, 95%CI (44.94, 55.18), P<0.05;at 6 months, MD =70.65, 95%CI (51.97, 89.33), P<0.05; at 9 months, MD = 48.88, 95%CI (43.15, 54.62), P<0.05.5. Lung function: 13 studies reported lung function.?FEV 1 :at 2 months, FEV1, standardized mean difference (SMD) = 0.84, 95% confidence interval (95%CI) (0.38, 1.29), P<0.05;at 6 months, SMD = 1.21,95%CI (0.96, 1.47), P<0.05;?FEVl/FVC: at 6 months, SMD = 2.54, 95%CI (1.10, 3.97), P<0.05.6. Depression and anxiety:6 studies reported depression and anxiety.①Anxiety:at 3 months, SMD=-3.05,95%CI (-3.37,-2.73), P<0.05;②Depression:at 3 months, MD=-21.34,95%CI (-23.23,-19.45), P<0.05;at 6 months, SMD=-0.90,95% CI(-1.23,-0.57), P<0.05.7. Self-efficacy:6 studies reported self-efficacy.①Negative affect:at 1 month, MD= 0.03,95%CI (-0.02,0.08), P>0.05; at 3 months, MD= 0.10,95%CI (0.04,0.17),P< 0.05;②Emotional arousal:at 1 month, MD= 0.24,95%CI (0.13,0.34), P<0.05; at 3 months, MD= 0.32,95%CI (0.21,0.43), P<0.05;at 6 months, SMD= 0.71,95%CI (0.44, 0.99),P<0.05;③Physical exertion:at 1 month, MD= 0.24,95%CI (0.14,0.35), P<0.05; at 3 months, MD= 0.31,95%CI (0.20,0.42),P<0.05;at 6 months, SMD= 0.76,95%CI (0.49,1.03),P< 0.05;④ Weather or environment:at 1 month, MD=0.2,95%CI (0.10, 0.30), P<0.05; at 3 months, MD= 0.28,95%CI (0.19,0.37), P<0.05; at 6 months, SMD= 0.93,95%CI (0.66,1.21),P<0.05;⑤Behavioural risk factors:at 1 month, MD= 0.16,95%CI (0.05,0.28), P<0.05;⑥Total score:at 1 month, MD= 0.24,95%CI (0.18, 0.30), P<0.05; at 3 months, MD= 0.24,95%CI (0.17,0.31), P<0.05;at 6 months, SMD= 0.82,95%CI (0.59,1.05),P<0.05.ConclusionTransitional care for COPD patients is a relatively safe health care model. In China, transitional care can reduce hospitalization for COPD patients within 6 months.but can not reduce the re-admission.the length of stay, visits to outpatient and emergency and medical costs have decreased. In foreign countries, transitional care can reduce the number of COPD patients admitted to hospital within 3 months and the emergency number, but can not reduce the number of hospital admissions and hospital days in 1 year, transitional care can improve the QOL of patients, reduce the degree of difficulty in breathing, but the effect of early intervention were not obvious; in addition, exercise capacity in patients, self-efficacy, anxiety and depression have a positive effect. transitional care can improve lung function, but the effect is not obvious. Because the study included the risk of bias in the study of unclear, part of the time to enter the Meta analysis of the number of research is less, the research conclusions of the intensity of the argument subject to certain restrictions. Therefore, it should be prudent to treat this conclusion. It is suggested that the future research focus on the effect and mechanism of transitional care, and the design and implementation of COPD patients in our country. |
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