Potential benefits of integrated COPD management in primary care

Abstract

Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable longterm effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis.

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

“…However, these interventions are underused or suboptimally implemented 2. Irregular exacerbations, fluctuating symptoms, and various disabilities require a collaborative interaction between actively involved patients and a proactive multidisciplinary team 3. Such interaction is promoted by integrated disease management programmes developed in response to the evidently unsuccessful reactive response to disease progression 2…”

Cost-effectiveness of integrated COPD care: the RECODE cluster randomised trial

“…Furthermore, the generalisability of the outcomes of these studies was low, due to the inclusion of patients with mainly severe COPD and the exclusion of patients with multimorbidity. 2 5 6 …”

Establishing a pulmonary rehabilitation programme in primary care in Greece: A FRESH AIR implementation study

“…57 Additionally, it provides the ground for multidisciplinary collaboration, patient empowerment and community reactivation, which are all core components of PR. Instigating integrated disease management programmes such as PR in primary care may assist not only with improving patient outcomes and quality of life 58,59 but also with increasing the overall level of care integration 60 with positive effects on systems and communities.…”