The impact of integrated disease management in high-risk COPD patients in primary care

Ferrone, Madonna; Masciantonio, Marcello G.; Malus, Natalie; Stitt, Larry; O’Callahan, Tim; Roberts, Zofe; Johnson, Laura; Samson, Jim; Durocher, Lisa; Ferrari, Mark; Reilly, Margo; Griffiths, Kelly; Licskai, Christopher J.; The Primary Care Innovation Collaborative; Atkins, Andrew; Baker, Bill; Dalo, Sara; Piccinato, Jean; Waddick, Denise; Wong, Brice

doi:10.1038/s41533-019-0119-9

Cited by 68Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesPrimary Care and Health Outcomes

The impact of integrated disease management in high-risk COPD patients in primary care

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Ferrone, Madonna, Masciantonio, Marcello G., Malus, Natalie, Stitt, Larry, O’Callahan, Tim, Roberts, Zofe, Johnson, Laura, Samson, Jim +12 more·2019·npj Primary Care Respiratory Medicine

DOI 10.1038/s41533-019-0119-9PMC PMC6438975

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Abstract

Abstract Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care. This was a one-year multi-center randomized controlled trial. High-risk, exacerbation-prone COPD patients were randomized to IDM provided by a certified respiratory educator and physician, or usual physician care. IDM received case management, self-management education, and skills training. The primary outcome, COPD-related QoL, was measured using the COPD Assessment Test (CAT). Of 180 patients randomized from 8 sites, 81.1% completed the study. Patients were 53.6% women, mean age 68.2 years, post-bronchodilator FEV1 52.8% predicted, and 77.4% were Global Initiative for Obstructive Lung Disease Stage D. QoL-CAT scores improved in IDM patients, 22.6 to 14.8, and worsened in usual care, 19.3 to 22.0, adjusted difference 9.3 (p < 0.001). Secondary outcomes including the Clinical COPD Questionnaire, Bristol Knowledge Questionnaire, and FEV1 demonstrated differential improvements in favor of IDM of 1.29 (p < 0.001), 29.6% (p < 0.001), and 100 mL, respectively (p = 0.016). Compared to usual care, significantly fewer IDM patients had a severe exacerbation, −48.9% (p < 0.001), required an urgent primary care visit for COPD, −30.2% (p < 0.001), or had an emergency department visit, −23.6% (p = 0.001). We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and HSU, in a high-risk primary care COPD population. Clinicaltrials.gov NCT02343055.

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Eight studies reported significant improvements in HRQOL.
“Eight studies reported significant improvements in HRQOL”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [71]
The Results (COPD-specific QoL—CCQ score; page not provided) report significant quality-of-life improvements in this study’s IDM group. The Discussion mentions improvements in a systematic review, but our copy does not say that eight studies reported significant improvements. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Six studies reported on COPD-specific outcomes.
“Six studies reported on COPD-specific outcomes”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [71]
Nine studies reported disease knowledge as an outcome.
“Nine studies reported disease knowledge as an outcome [52, 66–68, 71, 81, 82, 88, 93, 111].”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [71]

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Authors: Ferrone, M., Masciantonio, M. G., Malus, N., Stitt, L., O’Callahan, T., Roberts, Z., Johnson, L., Samson, J., Durocher, L., Ferrari, M., Reilly, M., Griffiths, K., Licskai, C. J., Collaborative, T. P. C. I., Atkins, A., Baker, B., Dalo, S., Piccinato, J., Waddick, D., & Wong, B.
Affiliations: Hôtel-Dieu Grace Healthcare (CA)
Western University (CA)
Lawson Health Research Institute (CA)
Windsor Family Health Team (CA)
Corresponding author: Licskai, Christopher J.
ORCID: Ferrone, Madonna
Licskai, Christopher J.
Venue: npj Primary Care Respiratory Medicine
Publisher: Springer Science and Business Media LLC
Published: 2019-03-28
Volume: 29
Issue: 1
Pages: 8-8
ISSN: 2055-1010 (ISSN-L)
DOI: 10.1038/s41533-019-0119-9
PMC: PMC6438975
OpenAlex: W2922849923
Cited by: 68
References: 46
Citations by year: 2026: 8 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 14 · 2021: 13 · 2020: 6 · 2019: 3
FWCI: 6.62
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
creativecommons.org/licenses/by/4.0 (vor)
Locations: npj Primary Care Respiratory Medicine (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: Asthma Research Group Windsor-Essex County Inc.
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords: chronic obstructive pulmonary disease, integrated disease management, self-management education, case management, COPD exacerbations, quality of life, health care utilization, primary care, FEV1, patient knowledge
MeSH terms: Aged, Emergency Service, Hospital, Female, Forced Expiratory Volume, Humans, Male, Primary Health Care, Quality of Life, Risk Factors, Self Care, Delivery of Health Care, Integrated, Pulmonary Disease, Chronic Obstructive

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