Complex interventions reduce COPD urgent care use
medwireNews: The authors of a systematic review say that the use of multicomponent, or complex, interventions in chronic obstructive pulmonary disease (COPD) could help reduce healthcare costs, after they found that the approach significantly reduced urgent care use.
In their analysis of 32 randomized trials assessing a range of intervention components in 3941 patients, authors Amy Blakemore (University of Manchester, UK) and colleagues found that urgent care use was reduced by 32%.
In particular, it was lowered by 34% with interventions that included a general education component, by 40% with those that involved exercise, and by 52% with those that involved relaxation therapy.
Interventions that involved skills training or relapse prevention did not result in significant changes to urgent care use.
However, the authors say that "since no individual study component made a significant independent contribution in the multivariable meta-regression, we conclude that, based on current evidence among people with COPD, reductions in the use of urgent care cannot be attributed to any single intervention component."
The analysis included primarily studies involving patients with COPD from secondary care, who underwent interventions involving a mean of 2.9 components, over an average of 13.9 sessions.
The authors explain that while most care for COPD takes place in primary care, around two-thirds of the costs are attributable to inpatient hospital care, and roughly one-quarter of patients make an emergency department visit each year.
Blakemore and colleagues note that their findings are in accordance with previous studies that found that treating anxiety and depression in patients with COPD can reduce emergency admissions. They also suggest that as exercise improves depression in primary care patients, it could be a mechanism through which exercise reduces emergency admissions in COPD patients.
Writing in Respiratory Medicine, they conclude that "complex interventions among people with COPD may reduce the use of urgent care, particularly those including education, exercise and relaxation."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter