Abstract
BackgroundImplementation of the COPD-Home integrated disease management (IDM) intervention at discharge after hospitalizations for acute exacerbations of COPD (AECOPD) led to reduced hospital utilization during the following 24 months compared to the year prior to study start.AimsTo analyze the impact of the COPD-Home IDM intervention on health related quality of life, symptoms of anxiety and depression, and the degree of patient activation during 24 months of follow-up and to assess the association between these outcomes.MethodsA single center, prospective, open, controlled clinical study. Changes in The St. George Respiratory Questionnaire (SGRQ), the Hospital anxiety (HADS-A) and depression (HADS-D) and the patient activation measure (PAM) scores were compared between the patients in the integrated care group (ICG) and the usual care group (UCG) 6, 12 and 24 months after enrolment.ResultsThe questionnaire response rate was 80–96%. There were no statistically significant differences in the change of the SGRQ scores between the groups during follow up. After 12 months of follow-up there was a trend towards a reduction in the mean HADS–A score in the ICG compared to the UCG. The HADS-D scores remained stable in the ICG compared with an increasing trend in the UCG. Clinically significant difference in the PAM score was achieved only in the ICG, 6.7 (CI95% 0.7 to 7.5) compared to 3.6 (CI95% -1.4 to 8.6) in the UCG. In a logistic regression model a higher HADS-D score and current smoking significantly increased the odds for a low PAM score.ConclusionThe COPD–Home IDM intervention did not result in any statistically significant changes in mean SGRQ, HADS-A, HADS- D or PAM scores during the 24 months of follow-up.Trial registrationThe ID number for the study in the Clinical.Trials.gov registration system is 17417. ClinicalTrials.gov Identifier: NCT 00702078
Highlights
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and represents an increasing economic and social burden [1]
George Respiratory Questionnaire (SGRQ), the Hospital anxiety (HADS-A) and depression (HADSD) and the patient activation measure (PAM) scores were compared between the patients in the integrated care group (ICG) and the usual care group (UCG) 6, 12 and 24 months after enrolment
There were no significant differences in the baseline characteristics between the IC or the UC groups with regards to age, gender, body mass index (BMI), lung function, COPD severity, the number of current cigarette smokers, the number of persons living alone, the burden of comorbidities or the number of participants receiving home nursing
Summary
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and represents an increasing economic and social burden [1]. A Cochrane review from 2013 of integrated disease management (IDM) interventions among COPD patients showed that IDM improved disease–specific quality of life and exercise capacity, and reduced the number of hospital admissions and in-hospital days per person [4]. In the study by Kruis et al [7] no additional benefit of IDM compared to usual care was found, except an improved level of integrated care and a higher degree of selfreported daily activities. Implementation of the COPD-Home integrated disease management (IDM) intervention at discharge after hospitalizations for acute exacerbations of COPD (AECOPD) led to reduced hospital utilization during the following 24 months compared to the year prior to study start
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