Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial
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OBJECTIVE: To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. DESIGN: 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. SETTING: 15 general practices in the eastern part of the Netherlands. PARTICIPANTS: Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. INTERVENTIONS: A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). OUTCOME MEASURES: The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. RESULTS: 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). CONCLUSIONS: Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. TRIAL REGISTRATION: Clinical trials NCT00128765.
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Seven RCTs reported non-significant improvements in self-efficacy.
“Seven RCTs reported non-significant improvements in self-efficacy”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [69]
The Results (Secondary outcomes; page unavailable) report no statistically significant changes or differences in self-efficacy, but the Discussion (Interpretation with reference to other studies; page unavailable) explicitly says patients did not show an improvement. This paper reports one RCT, not findings from seven RCTs. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredTwenty-four RCTs examined the impact of interventions on health-related quality of life (HRQOL).
“Twenty-four RCTs examined the impact of interventions on HRQOL”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [69]
The Abstract (Design and Objective) describes one 24-month randomised controlled trial assessing interventions' effects on quality of life. The Methods (Outcomes and follow-up) confirms that health-related quality of life was its primary outcome, but the paper does not report that 24 RCTs examined it. (LLM, conf=0.90)
Experimental — accuracy not yet measuredChanges in perceived self-efficacy were reported in 14 studies.
“Changes in perceived self-efficacy were reported in 14 studies”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [69]
The Methods (Outcomes and follow-up; page unavailable) identify change in self-efficacy scores as an outcome, and the Results (Secondary outcomes; page unavailable) report no statistically significant changes in this trial. The paper does not report that 14 studies assessed changes in perceived self-efficacy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSix 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 [69]
Bischoff et al. found no statistically significant changes in CSES scores at 24 months.
“Bischoff et al. found no statistically significant changes in CSES scores at 24 months”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [69]
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BackgroundSelf management for patients with chronic obstructive pulmonary disease
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- Authors
- Bischoff, E. W. M. A., Akkermans, R., Bourbeau, J., van Weel, C., Vercoulen, J. H., & Schermer, T. R. J.
- Affiliations
- Radboud University Medical Center (NL)
- McGill University Health Centre (CA)
- Corresponding author
- Bischoff, E. W. M. A.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-11-28
- Volume
- 345
- Issue
- nov28 1
- Pages
- e7642-e7642
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3514071
- OpenAlex
- W1770386523
- Cited by
- 137
- References
- 22
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 9 · 2019: 16 · 2018: 11 · 2017: 14 · 2016: 23 · 2015: 13 · 2014: 18 · 2013: 9
- FWCI
- 10.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion)
- European Respiratory Journal
- Funders
- ZonMw
- 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, self-management, routine monitoring, exacerbation management, quality of life, self-efficacy, telephone support, practice nurses, general practice, Chronic Respiratory Questionnaire, bronchodilators, prednisolone
- MeSH terms
- Aged, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Quality of Life, Surveys and Questionnaires, Self Care, Spirometry, Disease Management, Pulmonary Disease, Chronic Obstructive, General Practice
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