Printed patient education interventions to promote guided self management of ulcerative colitis : a systematic review

Abstract

Background: Ulcerative colitis (UC) occurs in remissions and relapses and requires frequent outpatient follow-ups for management by specialists. These visits may not always coincide with the need for attention leading to unnecessary outpatient visits, nonattendances, inadequate monitoring, patient dissatisfaction and increased costs. Self management and shared decision making with health professionals may help overcome such challenges. Use of printed patient education interventions as a self management technique in UC has been discussed in this review.

Objectives: To determine the impacts and implications of printed patient education interventions on patient empowerment, improved patient care, decreased healthcare use without burden on primary care and its impact on saving costs. The applicability of such an intervention in context of Hong Kong will also be discussed.

Methods: PubMed and ProQuest Health and Medicine Databases, and Google scholar search engine were searched for original studies reporting results of randomized controlled trials (RCTs) of use of printed patient education interventions in management of inflammatory bowel disease and ulcerative colitis. There was no limit put on publication dates.

Results: Four RCTs were finalized for review. The studies named primary and secondary outcomes, some of which were common to more than one study, and included process evaluations. Knowledge of UC was evaluated as an outcome in two studies, quality of life in four, health related anxiety and depression in two, patient satisfaction in two, medication adherence in one, relapses experienced in one and healthcare use in three. Knowledge and patient satisfaction was found to significantly improve in two studies. Statistically significant reduction was found in healthcare use in 2 RCTs with one also reporting fewer visits to outpatient department and primary care. Results were statistically insignificant for quality of life, medication adherence, relapse length, reporting of relapses and health related anxiety and depression in different studies though further study of their long-term effects is warranted to be better demonstrate their potential benefits.

Conclusion: The presently proposed printed materials used in the studies appear to produce modest benefits in self management of UC. As the idea of self management evolves with time, we would need to define the optimal format of printed intervention and ways for continuous reinforcement in patients, as, currently, UC management is a lifelong process.