¿Es útil la implantación de programas de gestión clínica de los pacientes con enfermedad pulmonar obstructiva crónica? Comparación de la efectividad de dos intervenciones sobre la evolución clínica y la atención recibida

Abstract

ObjectiveTo evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD). DesignA study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2months. SettingPrimary Care Centres in two Barcelona Health Areas and their referral hospitals. ParticipantsPatients with COPD selected by simple random sampling using any disease code corresponding to COPD. InterventionsI1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared. Main measurementsVariables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations. ResultsOf the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P=.034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P<.001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P<.003]). ConclusionsBoth interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD.