Abstract
We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for 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 ≥2 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 six and 12 months.
We identified 272 participants with COPD (157 intervention, 115 usual care); 49/157 (31%) completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at six months (adjusted between group difference 2.45 favouring intervention, 95%CI – 0.89 to 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, 0.19 to 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.
Footnotes
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Conflict of interest: Jenifer Liang reports grants from Boehringer Ingelheim, non-financial support from Lung Foundation Australia, non-financial support from Eastern Melbourne PHN, grants from National Health and Medical Research Council (Australia), during the conduct of the study.
Conflict of interest: Dr. Abramson reports grants from Boehringer-Ingelheim, during the conduct of the study; grants from Pfizer, other and personal fees from Sanofi, outside the submitted work.
Conflict of interest: Dr. Russell has nothing to disclose. Note that Cash and/or in-kind contributions were received from partner organisations: Lung Foundation Australia (LFA), Boehringer Ingelheim (BI) Pty Ltd and Eastern Melbourne PHN (EMPHN). The LFA and EMPHN 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 program and did not contribute to decisions regarding data analysis and dissemination of findings.
Conflict of interest: Dr. Holland reports grants from Boehringer Ingelheim, non-financial support from Lung Foundation Australia, non-financial support from Eastern Melbourne PHN, during the conduct of the study.
Conflict of interest: Dr. Zwar has nothing to disclose.
Conflict of interest: Dr. Bonevski has nothing to disclose.
Conflict of interest: Dr. Mahal has nothing to disclose.
Conflict of interest: Dr. Eustace has nothing to disclose.
Conflict of interest: Mr. Paul has nothing to disclose.
Conflict of interest: Dr. Phillips reports grants from National Health and Medical Research Council (NHMRC), grants from Boehringer Ingelheim, non-financial support from Eastern Melbourne PHN, non-financial support from Lung Foundation Australia, during the conduct of the study; and Kirsten Phillips was previously the Lung Foundation Australia's General Manager of the COPD National Program, Australia. The Lung Foundation Australia works in collaboration and receives funding from pharmaceutical companies outlined in the foundation's annual reports (available at: https://lungfoundation.com.au/about-us/annual-reports/).
Conflict of interest: Dr. Cox has nothing to disclose.
Conflict of interest: Dr. Wilson has nothing to disclose.
Conflict of interest: Dr. George reports grants from Boehringer-Ingelheim, during the conduct of the study; grants from Pfizer, personal fees from GSK, outside the submitted work; and JG is a current member of the Lung Foundation Australia COPD Guidelines Committee.
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