21 research outputs found
Cochrane corner: Is integrated disease management for patients with COPD effective?
Patients with COPD experience respiratory
symptoms, impairments of daily living and recurrent
exacerbations. The aim of integrated disease
management (IDM) is to establish a programme of
different components of care (ie, self-management,
exercise, nutrition) in which several healthcare providers
(ie, nurses, general practitioners, physiotherapists,
pulmonologists) collaborate to provide efficient and good
quality of care. The aim of this Cochrane systematic
review was to evaluate the effectiveness of IDM on
quality of life, exercise tolerance and exacerbation related
outcomes. Searches for all available evidence were
carried out in various databases. Included randomised
controlled trials (RCTs) consisted of interventions with
multidisciplinary (≥2 healthcare providers) and
multitreatment (≥2 components) IDM interventions with
duration of at least 3 months. Two reviewers
independently searched, assessed and extracted data of
all RCTs. A total of 26 RCTs were included, involving
2997 patients from 11 different countries with a followup
varying from 3 to 24 months. In all 68% of the
patients were men, with a mean age of 68 years and a
mean forced expiratory volume in 1 s (FEV1) predicted
value of 44.3%. Patients treated with an IDM
programme improved significantly on quality of life
scores and reported a clinically relevant improvement of
44 m on 6 min walking distance, compared to controls.
Furthermore, the number of patients with ≥1 respiratory
related hospital admission reduced from 27 to 20 per
100 patients. Duration of hospitalisation decreased
significantly by nearly 4 days
Primary Care COPD Patients Compared with Large Pharmaceutically-Sponsored COPD Studies:An UNLOCK Validation Study
Background: Guideline recommendations for chronic obstructive pulmonary disease (COPD) are based on the results of large pharmaceutically-sponsored COPD studies (LPCS). There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care.Objective: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD) on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials.Methods: Baseline data of seven primary care databases (n = 3508) from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria.Results: Overall, patients included in the LPCS were younger (mean difference (MD)-2.4; p = 0.03), predominantly male (MD 12.4; p = 0.1) with worse lung function (FEV1% MD -16.4; p <0.01) and worse quality of life scores (SGRQ MD 15.8; p = 0.01). There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with >= 1 and >= 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had >= 1 exacerbations per year and 12% had >= 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN) to 42% (ECLIPSE, UPLIFT).Conclusion: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care populations in their recommendations.</p
The health economic impact of disease management programs for COPD: A systematic literature review and meta-analysis
__Abstract__
Background: There is insufficient evidence of the cost-effectiveness of Chronic Obstructive Pulmonary Disease (COPD) Disease Management (COPD-DM) programs. The aim of this review is to evaluate the economic impact of COPD-DM programs and investigate the relation between the impact on healthcare costs and health outcomes. We also investigated the impact of patient-, intervention, and study-characteristics.Methods: We conducted a systematic literature review to identify cost-effectiveness studies of COPD-DM. Where feasible, results were pooled using random-effects meta-analysis and explorative subgroup analyses were performed.Results: Sixteen papers describing 11 studies were included (7 randomized control trials (RCT), 2 pre-post, 2 case-control). Meta-analysis showed that COPD-DM led to hospitalization savings of €1060 (95% CI: €2040 to €80) per patient per year and savings in total healthcare uti
Sustained effects of integrated COPD management on health status and exercise capacity in primary care patients
Annemarije L Kruis1, Joan van Adrichem2, Magda R Erkelens2, Huub Scheepers3, Hans in &rsquo;t Veen4, Jean WM Muris5, Niels H Chavannes11Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2Physiotherapy Center De Beweging, Rotterdam, 3Well-being Medical Center, Bocholtz-Simpelveld, 4Department of Pulmonary Diseases, Sint Franciscus Gasthuis, Rotterdam, 5Department of General Practice, Maastricht University Medical Center, The NetherlandsBackground: Chronic obstructive pulmonary disease (COPD) constitutes a growing health care problem worldwide. Integrated disease management (IDM) of mild to moderate COPD patients has been demonstrated to improve exercise capacity and health status after one year, but long-term results are currently lacking in primary care.Methods: Long-term data from the Bocholtz study, a controlled clinical trial comparing the effects of IDM versus usual care on health status in 106 primary care COPD patients during 24 months of follow-up, were analyzed using the Clinical COPD Questionnaire (CCQ). In addition, the Kroonluchter IDM implementation program has treated 216 primary care patients with mild to moderate COPD since 2006. Longitudinal six-minute walking distance (6MWD) results for patients reaching 24 months of follow-up were analyzed using paired-sample t-tests. In prespecified subgroup analyses, the differential effects of baseline CCQ score, Medical Research Council (MRC) dyspnea score, and 6MWD were investigated.Results: In the Bocholtz study, subjects were of mean age 64 years, with an average postbronchodilator forced expiratory volume in one second (FEV1) of 63% predicted and an FEV1/forced vital capacity (FVC) ratio of 0.56. No significant differences existed between groups at baseline. CCQ improved significantly and in a clinically relevant manner by 0.4 points over 24 months; effect sizes were doubled in patients with CCQ &gt; 1 at baseline and tripled in patients with MRC dyspnea score &gt; 2. In the Kroonluchter cohort, 56 subjects completed follow-up, were of mean age 69 years, with an FEV1/FVC ratio of 0.59, while their postbronchodilator FEV1 of 65% predicted was somewhat lower than in the total group. 6MWD improved significantly and in a clinically relevant manner up to 93 m at 12 months and was sustained at 83 m over 24 months; this effect occurred faster in patients with MRC dyspnea score &gt; 2. In patients with baseline 6MWD &lt; 400 m the improvement remained &gt;100 m at 24 months.Conclusion: In this study, IDM improved and sustained health status and exercise capacity in primary care COPD patients during two years of follow-up. Improvements in health status are consistently higher in patients with CCQ &gt; 1 at baseline, being strongest in patients with baseline MRC dyspnea score &gt;2. Improvements in exercise capacity remain highest in patients with 6MWD &lt; 400 m at baseline and seem to occur earlier in patients with MRC dyspnea score &gt;2.Keywords: chronic obstructive pulmonary disease, disease management, integrated care, pulmonary rehabilitation, primary car
Successful patient self-management of COPD requires hands-on guidance
Prevention, Population and Disease management (PrePoD