An integrated disease management (IDM) and structured follow up intervention reduces severe exacerbations and urgent primary care visits in people with high risk COPD.
This is the finding of a Canadian study published in NPJ Primary Care Respiratory Medicine. It is the first study to demonstrate that IDM substantially improves COPD-related quality of life (QoL), say the authors.
The researchers randomised 180 high risk, exacerbation prone patients with COPD from 8 sites to IDM care involving a team approach with a healthcare professional trained in patient education, or usual physician care. More than 80% of patients completed the trial.
The intervention subjects received on-site spirometry, case management, education, and skills training, including self-management education at the start of the study, 3 months post-enrollment and either a telephone contact or in-person visit at 6 and 9 months (15–30 min). All visits occurred in the primary care practice where the individual normally received care.
All IDM patients received inhaler device instruction and all patients had a written self-management action plan. Nearly all (95.8%) patients reported using their plan, 58.3% had a prescription at home for prednisone and/or antibiotics to self-activate if needed, and 72.2% reported they were confident using their plan.
COPD-related QoL was measured using the COPD Assessment Test (CAT). QoL-CAT scores improved in IDM patients, and worsened in usual care. Compared to usual care, significantly fewer IDM patients had a severe exacerbation, (48.9%), required an urgent primary care visit for COPD (30.2%) or had an emergency department visit (23.6%).
“We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and high use of health services in a high-risk primary care COPD population,” say the researchers.
If you are interested in finding out more about the development of integrated care in the UK, this article on multidisciplinary virtual clinics published in Primary Care Respiratory Medicine highlights some of the successful initiatives being pioneered by PCRS members.
PCRS Executive Chair Dr Noel Baxter says: “It is of course no surprise that people with advanced and complex COPD need more than one individual or intervention to really impact on outcomes. It is a fundamental tenet of Value Based Health Care that the system and not a single service must respond to the challenge of improvement. This study adds weight to the ask of the health care system to support the transformation to a multi-disciplinary approach for people with complex care issues”