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15-07-2009 | Respiratory | Article

Integrated management program improves QoL for COPD patients

Abstract

Free abstract

MedWire News: An integrated disease management (IDM) program is more effective than usual care for improving the quality of life (QoL) of primary care patients with chronic obstructive pulmonary disease (COPD), researchers report.

“Pragmatic primary care studies in which optimal medical and non-medical treatments are combined into an IDM [COPD] intervention are needed, but to our knowledge have been lacking to this date,” explain Niels Chavannes (Leiden University Medical Center, The Netherlands) and team.

To address this, the researchers studied 152 patients (63% male), aged an average of 63 years, with mild-to-moderate COPD from two primary health care centers in The Netherlands.

Patients from one center (n=73) were assigned to usual care while those from the other center (n=79) were assigned to an IDM program consisting of optimal medication, reactivation, education, and exacerbation management delivered by a dedicated multidisciplinary team.

The participants had an average post-bronchodilator FEV1 of 67% predicted, an average FEV1/forced vital capacity (FVC) ratio of 0.65, and a mean of 35 pack-years smoking, with no significant differences between the two groups at baseline.

The participants’ QoL was assessed at the start of the study and after 1 year of IDM using the St George’s Respiratory Questionnaire (SGRQ), with a 4.0-point reduction in SGRQ defined as the minimal clinically important QoL improvement.

At the end of the study period, the researchers found that, overall, SGRQ scores had decreased by 4.6 points in the intervention group versus just 0.7 points in the usual care group. Among patients with an FEV1/FVC ratio <0.7, SGRQ scores fell by 5.9 points and 0.8 points in the two groups, respectively.

Furthermore, in patients with a Medical Research Council dyspnea score >2 and an FEV1/FVC ratio <0.7, SGRQ scores decreased by 13.4 points in the IDM group versus 0.3 points in the usual care group.

Chavannes and team conclude: “In this study, IDM improves 1-year QoL in primary care COPD patients, compared to usual care. The improvement in SGRQ was both clinically relevant and statistically significant.”

They add: “This pragmatic controlled clinical trial shows that, contrary to common belief, primary care COPD patients can be successfully treated, provided a dedicated multidisciplinary team is in place.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Mark Cowen

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