Abstract
We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for chronic obstructive pulmonary disease (COPD).
A cluster randomised controlled trial was conducted in 43 general practices in Australia. Adults with a history of smoking and/or COPD, aged ≥40 years with two or more clinic visits in the previous year were enrolled following spirometric confirmation of COPD. The model of care comprised smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase). Main outcomes included changes in St George's Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), dyspnoea, smoking abstinence and lung function at 6 and 12 months.
We identified 272 participants with COPD (157 intervention, 115 usual care); 49 (31%) out of 157 completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at 6 months (adjusted between-group difference 2.45 favouring intervention, 95% CI –0.89–5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ in those receiving the full intervention compared to usual care (difference 5.22, 95% CI 0.19–10.25). No statistically significant differences were observed in change in CAT, dyspnoea, smoking abstinence or lung function.
No significant evidence was found for the effectiveness of this interdisciplinary model of care for COPD in primary care over usual care. Low uptake was a limitation.
Abstract
An interdisciplinary model of care for COPD in primary care involving smoking cessation support, home medicines review, and home-based pulmonary rehabilitation did not demonstrate superiority over usual care; low uptake by GPs and patients was a challenge http://ow.ly/DmkC30nxL9D
Footnotes
This article has supplementary material available from erj.ersjournals.com
This study was registered at www.anzctr.org.au/ with identifier number ACTRN12614001155684. Anonymous patient level data, technical appendix and statistical code are available on reasonable request from the corresponding author, but may require ethics approval.
Author contributions: J. George conceived the research idea and developed it with input from chief investigators. M.J. Abramson, G. Russell, N.A. Zwar, A.E. Holland, B. Bonevski and A. Mahal. Representatives of partner organisations (K. Phillips and P. Eustace) contributed to discussions. J. Liang is a PhD student working under the supervision of M.J. Abramson and J. George. J. Liang coordinated data collection and data management. E. Paul and J. Liang carried out statistical analyses required for the manuscript. S. Wilson was the project manager responsible for the recruitment of clinics and the overall conduct of the study. N.S. Cox coordinated delivery of the HomeBase programme. J. Liang drafted the original manuscript draft. All authors contributed to data interpretation and manuscript revision, and provided approval of the final manuscript.
Conflict of interest: M.J. Abramson reports grants from Boehringer Ingelheim, during the conduct of the study; grants from Pfizer, assistance with conference attendance and personal fees for consultancy from Sanofi, outside the submitted work.
Conflict of interest: G. Russell has nothing to disclose.
Conflict of interest: A.E. Holland is a current member of the Lung Foundation Australia COPD-X: Concise Guide for Primary Care Advisory Committee.
Conflict of interest: N.A. Zwar is a current member of the Lung Foundation Australia COPD Guidelines Committee.
Conflict of interest: B. Bonevski has nothing to disclose.
Conflict of interest: A. Mahal has nothing to disclose.
Conflict of interest: P. Eustace has nothing to disclose.
Conflict of interest: E. Paul has nothing to disclose.
Conflict of interest: K. Phillips is the Lung Foundation Australia General Manager of Consumer Programs. The Lung Foundation Australia works in collaboration and receives funding from pharmaceutical companies outlined in the foundation's annual reports (available at lungfoundation.com.au/about-us/annual-reports/).
Conflict of interest: N.S. Cox has nothing to disclose.
Conflict of interest: S. Wilson has nothing to disclose.
Conflict of interest: J. George reports grants from Boehringer Ingelheim, during the conduct of the study; grants from Pfizer, and personal fees for consultancy from GSK, outside the submitted work; and is a current member of the Lung Foundation Australia COPD Guidelines Committee.
Conflict of interest: J. Liang has nothing to disclose.
Support statement: We wish to thank all our funding bodies and partner organisations for supporting the trial (Boehringer Ingelheim, Eastern Melbourne PHN, Lung Foundation Australia and National Health and Medical Research Council). Lung Foundation Australia and Eastern Melbourne PHN were involved in project design and conduct, and contributed to data interpretation and writing of manuscripts. Boehringer Ingelheim was involved in project discussions, planning and progress review, but had no involvement in the design of the intervention programme and did not contribute to decisions regarding data analysis and dissemination of findings. B. Bonevski is supported by an Australian National Health and Medical Research Council Career Development Fellowship (GNT1063206) and a Faculty of Health and Medicine, University of Newcastle Gladys M Brawn Career Development Fellowship. J. Liang is the recipient of the Cyril Tonkin Scholarship 2014 (Faculty of Pharmacy and Pharmaceutical Sciences Foundation Board, Monash University). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 13, 2018.
- Accepted January 25, 2019.
- Copyright ©ERS 2019