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Cited by 226Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesRespiratory Support and Mechanisms

Glasgow Supported Self-management Trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial

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Bucknall, C. E., Miller, G., Lloyd, S. M., Cleland, J., McCluskey, S., Cotton, M., Stevenson, R. D., Cotton, P. +1 more·2012·BMJ
DOI 10.1136/bmj.e1060PMC PMC3295724
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Abstract

OBJECTIVE: To determine whether supported self management in chronic obstructive pulmonary disease (COPD) can reduce hospital readmissions in the United Kingdom. DESIGN: Randomised controlled trial. SETTING: Community based intervention in the west of Scotland. PARTICIPANTS: Patients admitted to hospital with acute exacerbation of COPD. INTERVENTION: Participants in the intervention group were trained to detect and treat exacerbations promptly, with ongoing support for 12 months. MAIN OUTCOME MEASURES: The primary outcome was hospital readmissions and deaths due to COPD assessed by record linkage of Scottish Morbidity Records; health related quality of life measures were secondary outcomes. RESULTS: 464 patients were randomised, stratified by age, sex, per cent predicted forced expiratory volume in 1 second, recent pulmonary rehabilitation attendance, smoking status, deprivation category of area of residence, and previous COPD admissions. No difference was found in COPD admissions or death (111/232 (48%) v 108/232 (47%); hazard ratio 1.05, 95% confidence interval 0.80 to 1.38). Return of health related quality of life questionnaires was poor (n=265; 57%), so that no useful conclusions could be made from these data. Pre-planned subgroup analysis showed no differential benefit in the primary outcome relating to disease severity or demographic variables. In an exploratory analysis, 42% (75/150) of patients in the intervention group were classified as successful self managers at study exit, from review of appropriateness of use of self management therapy. Predictors of successful self management on stepwise regression were younger age (P=0.012) and living with others (P=0.010). COPD readmissions/deaths were reduced in successful self managers compared with unsuccessful self managers (20/75 (27%) v 51/105 (49%); hazard ratio 0.44, 0.25 to 0.76; P=0.003). CONCLUSION: Supported self management had no effect on time to first readmission or death with COPD. Exploratory subgroup analysis identified a minority of participants who learnt to self manage; this group had a significantly reduced risk of COPD readmission, were younger, and were more likely to be living with others. TRIAL REGISTRATION: Clinical trials NCT 00706303.

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Crossref · 10.1136/bmj.e1060

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  • When individuals with a chronic condition like COPD actively participate in self-management, their medical outcomes improve.

    “The evidence is clear that when individuals with a chronic condition, like COPD, actively participate in their own care through self-management, their medical outcomes improve.”

    From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [37]

    The Successful self management section reports fewer COPD readmissions among participants who successfully used self-management techniques. But the Conclusions section says the intervention had no overall effect on COPD readmissions or deaths; the benefit came from an exploratory subgroup analysis. The claim presents that narrower finding as a clear, general improvement in medical outcomes. (LLM, conf=0.88)

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  • At the time this study was launched, the rate of 12-month readmission was about 50% in our preliminary data.

    “First, at the time this study was launched, the rate of 12-month readmission was about 50% in our preliminary data (Table 1), consistent with previously published data (41).”

    From Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study (2016) · cites this paper as [41]

  • The mere prescription of a written action plan for exacerbations is not sufficient to produce a difference in hospitalization in COPD.

    “In addition, there is clear evidence that the mere prescription of a written action plan for exacerbations is not suf fi cient to produce a difference in hospitalization in COPD (41).”

    From Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study (2016) · cites this paper as [41]

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2 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Walters JAE, Turnock AC, Walters EH, Wood Baker R. Action plans and limited patient education only for exacerbations of COPD (review). Cochrane Database Syst Rev 2010;5:CD005074.
  2. Monninkhof E, van der Valk P, van der Palen J, van Herwaarden C, Partridge MR, Zielhuis G. Self-management education for patients with COPD : a systematic review. Thorax 2003;58:394-8.
  3. Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GK, Nelson NA.Antibiotic therapy in exacerbations of COPD. Ann Intern Med 1987;106:196-204.
  4. Wong AWM, Gan WQ, Burns J, Sin DD, van Eeden SF. Acute exacerbation of COPD: influence of social factors in determining length of stay and readmission rates. Can Respir J 2008;15:361-4.
  5. Xu W, Collet JP, Shapiro S, Lin Y, Yang T, Platt R, et al. Independent effect of depression and anxiety on COPD exacerbations and hospitalizations. Am J Respir Crit Care Med 2008;178:913-20.
  6. Silverman J, Kurtz SM, Draper J. The Calgary-Cambridge approach to communication skills teaching I: agenda-led outcome based analysis of the consultation. Education for General Practice 1996;7:288-99.
  7. Silverman J, Draper J, Kurtz SM. The Calgary-Cambridge approach to communication skills teaching II: the SET-GO method of descriptive feedback. Education for General Practice 1997;8:16-23.

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Authors
Bucknall, C. E., Miller, G., Lloyd, S. M., Cleland, J., McCluskey, S., Cotton, M., Stevenson, R. D., Cotton, P., & McConnachie, A.
Affiliations
  • Glasgow Royal Infirmary (GB)
  • University of Glasgow (GB)
  • University of Aberdeen (GB)
Corresponding author
Bucknall, C. E.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2012-03-06
Volume
344
Issue
mar06 1
Pages
e1060-e1060
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.e1060
PMC
PMC3295724
OpenAlex
W2045340501
Cited by
226
References
28
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 12 · 2022: 10 · 2021: 13 · 2020: 11 · 2019: 15 · 2018: 14 · 2017: 32 · 2016: 27 · 2015: 22 · 2014: 31 · 2013: 22 · 2012: 7
FWCI
21.16
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion, cc-by-nc)
Funders
GlaxoSmithKline
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
self-management support, chronic obstructive pulmonary disease, COPD exacerbations, hospital readmission, COPD mortality, self-management education, community-based intervention, health-related quality of life, Scotland, socioeconomic deprivation, pulmonary rehabilitation, FEV1, mortality risk factors, predictors of readmission
MeSH terms
Acute Disease, Adaptation, Psychological, Aged, Epidemiologic Methods, Female, Forced Expiratory Volume, Humans, Male, Patient Acceptance of Health Care, Patient Education as Topic, Patient Readmission, Quality of Life, Scotland, Self Care, Sputum, Outcome Assessment, Health Care, Case Management, Self Efficacy, Pulmonary Disease, Chronic Obstructive

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