Integrated disease management interventions for patients with chronic obstructive pulmonary disease

Poot, Charlotte C; Meijer, Eline; Kruis, Annemarije; Smidt, Nynke; Chavannes, Niels H.; Honkoop, Persijn

doi:10.1002/14651858.cd009437.pub3

Cited by 27 publications

(43 citation statements)

References 258 publications

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“…Integrated disease management is associated with a reduction in HSU. 15–17 , 21 A history of COPD exacerbation is highly correlated with an increased risk of future exacerbations and an associated acceleration of disease progression. 36 In part, this may explain the relationship observed in this study between prior exacerbation (measured by antibiotic and prednisone use) and urgent HSU in the year of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…This point is well illustrated in a recently updated meta-analysis that evaluated the impact of IDM from 52 randomized controlled trials (RCTs). 21 The programs ranged from, involving 2 to 7 health professionals, delivering 2 to 8 IDM components, with program durations of 3 to 48 months. Furthermore, they were conducted in all types of healthcare setting (primary, secondary and tertiary) and spanned five continents where there is probably a large variation in usual care.…”

Section: Introductionmentioning

confidence: 99%

“…Dominant IDM subtypes identified by the studies included exercise predominant, self-management with exacerbation action-plans, structured follow-up and case management, and telemonitoring. 21 Acknowledging this heterogeneity, meta-analyses of randomized controlled trials (RCTs) examining IDM have confirmed a favorable impact on health-related QoL, emergency department (ED) visits, and hospital admissions. 15–17 , 21 …”

Section: Introductionmentioning

confidence: 99%

“… 21 Acknowledging this heterogeneity, meta-analyses of randomized controlled trials (RCTs) examining IDM have confirmed a favorable impact on health-related QoL, emergency department (ED) visits, and hospital admissions. 15–17 , 21 …”

Section: Introductionmentioning

confidence: 99%

“…The impact of IDM implemented in primary care is less certain with both positive and negative studies. 21–27 In community COPD programs, outside of the rigid controls of an RCT, there is an even greater potential that implementation heterogeneity will affect program outcomes. Similarly, there are limited and conflicting studies investigating the impact of IDM on primary care COPD populations in real-world clinical programs.…”

Section: Introductionmentioning

confidence: 99%

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Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study

Hussey¹,

Wing

Ferrone³

et al. 2021

COPD

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Purpose Integrated disease management (IDM) for COPD in primary care has been primarily investigated under clinical trial conditions. We previously published a randomized controlled trial (RCT) where the IDM intervention improved quality of life (QoL) and exacerbation-related outcomes. In this study, we assess the same IDM intervention in a real-world evaluation and identify patient characteristics associated with improved outcomes. Methods This historical cohort study included patients enrolled for 12 (±3 months) in the Best Care COPD IDM program. The main outcome was a ≥3 point improvement in COPD assessment test (CAT). Secondary outcomes were COPD exacerbations requiring antibiotics and/or prednisone, unscheduled physician visits, emergency department visits and hospitalizations. Results Data for 571 patients ( all patients) were included, 158 met the reference RCT eligibility (RCT matched) . Improved QoL was observed in 43% (95% CI:38.9,47.2) of all patients , 47% (95% CI:39.5,55.6) of RCT matched vs 92% (95% CI:79.2,95.1) in the reference RCT intervention arm (n=72). Reductions (12 months IDM vs prior year) were observed in the proportion of patients experiencing exacerbation-related events ( all patients ): antibiotics/prednisone (−9.0%,95% CI:-13.9,-3.9); unscheduled physician (−33.1%,95% CI:-38.2,-27.9); emergency department (−9.6%,95% CI:-13.5,-5); and hospitalizations (−6.8%,95% CI:-10.0,-3.7). For the RCT matched group all reductions were comparable to the reference RCT intervention arm. The strongest predictors of improved QoL were baseline CAT, CAT≥20 vs CAT<10 (OR 15.6,95% CI:7.91,30.83), GOLD group B (OR 6.4,95% CI:3.42,11.85) and D (OR 5.64,95% CI:2.80,11.37) vs GOLD group A. Patients with prior antibiotic/prednisone use, FEV 1 <30% predicted and GOLD group D were less likely to have no urgent health service utilization (OR 0.5,95% CI:0.30,0.68), (OR 0.2,95% CI:0.07,0.78) and (OR 0.3,95% CI:0.14,0.51), respectively. Conclusion Best Care COPD improved QoL and reduced exacerbation-related outcomes in a manner directionally similar to the RCT from which it emanated. Baseline QoL, exacerbation history, and GOLD category were identified as possible predictors of IDM impact and will inform future program development and resource allocation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study

Hussey¹,

Wing

Ferrone³

et al. 2021

COPD

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Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care

Cross

Thomas

Liang

et al. 2022

Cochrane Database of Systematic Reviews

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BackgroundChronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. ObjectivesTo review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. Search methodsWe searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. Selection criteriaWe included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. Data collection and analysisTwo review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-e ects models to yield summary estimates of e ect (mean di erences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations.Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care (Review)

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Non-pharmacological interventions for the prevention of hospitalisations in stable chronic obstructive pulmonary disease: component network meta-analysis

Jones

McKenzie

Osadnik

et al. 2022

Cochrane Database of Systematic Reviews

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Integrated disease management interventions for patients with chronic obstructive pulmonary disease

Cited by 27 publications

References 258 publications

Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study

Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study

Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care

Non-pharmacological interventions for the prevention of hospitalisations in stable chronic obstructive pulmonary disease: component network meta-analysis

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