Does education of primary care professionals promote patient self-management and improve outcomes in chronic disease? An updated systematic review

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Figure 1. PRISMA flow diagram (see Table 1 for definition of exclusion code). F/T = full-text.

Table 1. Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria	Exclusion code
English articles	Non-English articles	Eng
Adults (aged ≥18 years)	Study population aged <18 years	Age
Primary care or community	Secondary care or hospital	Not PC
Chronic conditions, chronic illness, chronic disease, non-communicable disease (NCD)	Acute conditions	Acute
Study type: systematic reviews, meta-analysis, RCTs, controlled clinical trials, interrupted time series, controlled before-and-after studies	Study type: qualitative studies, populations studies, surveys, cross sectional, uncontrolled before-and-after studies (cohort)	Study
Education and training of primary care health professionals for patient education in promoting change, behaviour change, lifestyle change, patient engagement, patient empowerment, motivational skills, patient collaboration, patient adherence and compliance, patient self-management, decision making, and patient problem-solving	Not education or training of healthcare professionals	Int
	Not primary care health professionals	Pop
	Primary outcome measures not included	Out
	Direct patient education only	Edu
Continuing education, CME, lifelong learning, or evidence-based medicine	Guideline adherence, clinical performance (no educational component involved)	Guid
All studies published from 1 September 2013 to 31 August 2018	Any article outside this timeframe	Date
	Organisational interventions	Org
	Financial changes and incentives	Fi
	Regulatory interventions	Reg

CME = continuing medical education. PC = primary care. RCTs = randomised controlled trials.

Table 2. Quality rating of included papers

First author	GlobalScore	Selection bias	Study design	Confounders	Blinding	Data collection methods	Withdrawals and drop outs
Tobe²⁹	weak	weak	mod	weak	weak	strong	mod
Kruis³⁰	mod	weak	strong	strong	mod	strong	mod
Vicens³¹	strong	strong	strong	strong	weak	strong	strong
Keeley³²	strong	mod	strong	strong	strong	strong	strong
Kristoffersen³³	mod	weak	strong	strong	strong	strong	strong
van Dijk-de Vries³⁴	weak	weak	strong	weak	mod	strong	mod
Racic³⁵	strong	strong	strong	strong	mod	strong	strong
Vicens³⁶	strong	strong	strong	strong	strong	strong	strong
Kristoffersen³⁷	mod	weak	strong	strong	strong	strong	strong
Zwar³⁸	weak	weak	strong	strong	strong	mod	strong
van Lieshout³⁹	mod	weak	strong	strong	mod	strong	strong
Vaillant-Roussel⁴⁰	mod	weak	strong	mod	mod	strong	mod
Griffiths⁴¹	strong	strong	strong	mod	mod	strong	mod
Eikelenboom⁴²	strong	strong	strong	strong	mod	strong	strong
Ramli⁴³	mod	strong	strong	strong	weak	strong	strong
Keeley⁴⁴	mod	weak	strong	strong	mod	strong	strong
Kristoffersen⁴⁵	weak	weak	strong	strong	weak	strong	strong
Baldeón⁴⁶	weak	weak	strong	weak	mod	strong	mod

BJGPO.2020.0186.pdf -
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