COPD collaborative self-management in primary care: A randomized controlled trial

Abstract

Background: Chronic obstructive pulmonary disease (COPD) impacts significantly on patients' quality of life (QoL) and health service utilization (HSU).

Objective: Develop and evaluate a primary care, interdisciplinary, collaborative self-management (CSM) intervention for patients with COPD. We hypothesized that CSM would improve QoL and reduce HSU.

Methods: In a multi-centre RCT subjects were randomized to either CSM (case management & comprehensive education by a certified respiratory educator & physician) at baseline & 3 months, telephone contacts at 6 and 9 months, or to receive usual physician care. Primary outcome QoL-COPD Assessment Test(CAT) at 12 months

Results: We recruited 181 subjects from 4 group practices, 145(80%) completed 12 months. 79/145(54.5%) women, mean(SD) age 67.7(10.2) years, FEV1 55.1%(15.8)predicted. Changes in CAT: CSM baseline mean(SD) 22.5(7.1) to 14.9(5.9); difference -7.4; control 19.7(7.0) to 22.3(6.6); difference 2.8; difference in CAT change 10.2, p<0.001). CAT improved > the minimum clinically important difference (MCID): CSM 63/71(88.7%); control 5/74(6.8%), p<.001. Subjects requiring >1 urgent/emergent visit for COPD: outpatient visit CSM 31/77(40.3%); control 54/74(73%); difference 32.7%(95%CI=17.8-47.6), p<.001; emergency room 10/77(13.0%) vs 29/74(39.2%); difference 26.2%,(95%CI=12.8-39.6) p<.001; hospitalization 8/77(10.4%) vs 13/74(17.6%); difference 7.2%, p=0.203.

Conclusion: Interdisciplinary care with CSM improved health and societal outcomes in moderate to severe COPD patients in primary care including: substantial improvement mean QoL; a 10-fold increase in subjects attaining improved QoL; and significantly fewer subjects requiring urgent/emergent HSU.