Chronic obstructive pulmonary disease management trials, including coordinated care, outreach nursing, and other attempted care innovations

Abstract

Chronic obstructive pulmonary disease (COPD) is associated with considerable morbidity, mortality and financial cost burden to society. In recognition of this growing problem, a diverse range of COPD management guidelines and interventions have been created, and some have been formally evaluated. Attempts to improve care through these practices have demonstrated only limited patient outcome benefit, while coordinated care trials and self-management innovations also have not provided large benefits when rigorously evaluated. However, amongst the diverse range of interventions, there are areas that are promising with respect to patients most likely to benefit, and intervention components most likely to yield improvements in symptoms and quality of life. A shift in admissions from reactive emergency admissions, to proactive elective admissions, while not necessarily achieving a total overall reduction in admissions and costs, should still be considered worthwhile in terms of societal value.