Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial

Abstract

Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care.Design 24 month, multicentre, pragmatic cluster randomised controlled trial Setting 40 general practices in the western part of the Netherlands Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team.

Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial

“…A recent multicentre, pragmatic cluster RCT in the Netherlands found that an integrated disease management approach delivered in the primary care setting led to no additional benefit compared with usual care in terms of QOL and COPD exacerbation rates of the patients when evaluated at 24 months 39. Another study even found that a comprehensive care management programme could not decrease COPD-related hospitalisations and the trial was terminated prematurely because of the unanticipated excess mortality in the active arm 40.…”

Integrated Care: What does this Mean for the COPD Patient?

“…For example, a large, 24-month, randomized controlled trial of what the authors called integrated disease management and implemented by general practitioners involved training of clinicians on the diagnosis and management of COPD, motivational interviewing, self-management action plans, web based decision support and fostering of networks [23]. In general, this intervention was not successful in its primary outcome, which was health status, or in most of its secondary outcomes, including hospital days.…”

Finding the royal way to stimulate and evaluate integrated care in Europe

“…9,10 Piloting single integrated care models should be designed to inform the feasibility of delivering integrated care on a small scale. Failing to do that, policy and organisational barriers as well as practical shortcomings may jeopardise the delivery of integrated care models.…”