Primary care patients with mild or stable chronic obstructive pulmonary disease need more support in disease management: a secondary analysis of a cluster randomized controlled trial

Abstract

Objective Patient education based on the patient’s individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients’ subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education. Design A secondary analysis of a cluster randomized controlled trial Setting 22 PHCCs in Stockholm, Sweden Subjects Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 293) Outcome measures Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18 months, spirometry results, and self-reported, descriptive patient data. Results GPs’ improved skills in COPD did not affect patients’ self-management skills over time. In general, patients’ information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93–5.23], p < .01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05–4.86], p = .038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD. Conclusion Patients’ information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient’s current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education. Trial registration Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809.