Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

• Published in: BMJ (Online) Vol. 345; no. 7885; p. 14
• Main Authors: Bischoff, Erik W M A, Akkermans, Reinier, Bourbeau, Jean, van Weel, Chris, Vercoulen, Jan H, Schermer, Tjard R J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 28.11.2012; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Aged; Antibiotics; Bronchitis; Bronchodilators; Chronic obstructive pulmonary disease; Clinical outcomes; Clinical trials; Comorbidity; Correspondence management; Disease Management; Double-Blind Method; Evidence-based medicine; Exercise; Family physicians; Female; Follow-Up Studies; General practice; General Practice - methods; Health outcomes; Humans; Long-term effects; Lung diseases; Male; Obstructive lung disease; Patients; Practice management; Prednisolone; Primary care; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Research universities; Self Care - methods; Self efficacy; Spirometry; Surveys and Questionnaires; Thorax; Universities; Netherlands
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.e7642

Objective To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients’ management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice.Design 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial.Setting 15 general practices in the eastern part of the Netherlands.Participants Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded.Interventions A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients’ own initiative).Outcome measures The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients’ management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. Results 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58).Conclusions Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group.Trial registration Clinical trials NCT00128765.