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Copyright ©ERS Journals Ltd 2005
Self-management reduces both short- and long-term hospitalisation in COPD
1 Respiratory Epidemiology and Clinical Research Unit, McGill University and Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, and 4 Hôpital du Sacré-Coeur, 5 Hôpital Maisonneuve-Rosemont, 6 Hôpital Notre-Dame, Centres Hospitaliers Affiliés de l'Université, Montréal, and 2 Hôpital du St-Sacrement, Centre Universitaire Affilié de l'Université Laval, Québec, 3 Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Ste-Foy, and 7 Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
CORRESPONDENCE: J. Bourbeau, Respiratory Epidemiology and Clinical Research Unit, 3650 St Urbain Street, Montréal, Québec, H2X 2P4, Canada. Fax: 1 5148432083. E-mail: jean.bourbeau{at}mcgill.ca
Keywords: Chronic obstructive pulmonary disease, education, hospital utilisation, long-term care, self-management
Received: August 9, 2004
Accepted July 18, 2005
The aim of the present study was to assess the long-term impact on hospitalisation of a self-management programme for chronic obstructive pulmonary disease (COPD) patients.
A multicentre, randomised clinical trial was carried out involving 191 COPD patients from seven hospitals. Patients who had one or more hospitalisations in the year preceding study enrolment were assigned to a self-management programme "Living Well with COPDTM" or to standard care. Hospitalisations from all causes were the primary outcome and were documented from the provincial hospitalisation database; emergency visits were recorded from the provincial health insurance database.
Most patients were elderly, not highly educated, had advanced COPD (reflected by a mean forced expiratory volume in one second of 1 L), and almost half reported a dyspnoea score of 5/5 (modified Medical Research Council). At 2 years, there was a statistically significant and clinically relevant reduction in all-cause hospitalisations of 26.9% and in all-cause emergency visits of 21.1% in the intervention group as compared to the standard-care group. After adjustment for the self-management intervention effect, the predictive factors for reduced hospitalisations included younger age, sex (female), higher education, increased health status and exercise capacity.
In conclusion, in this study, patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period.
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