The impact of integrated disease management in high-risk COPD patients in primary care

Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .

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Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

10.21203/rs.2.17741/v2 ◽

2020 ◽

Author(s):

Eline Meijer ◽

Annelies E. van Eeden ◽

Annemarije L. Kruis ◽

Melinde R.S. Boland ◽

W. J.J. (Pim) Assendelft ◽

...

Keyword(s):

Primary Care ◽

Disease Management ◽

Usual Care ◽

Clinical Improvement ◽

Patient Characteristics ◽

Integrated Disease Management ◽

Copd Patients ◽

Treatment Type ◽

Post Hoc ◽

Over Time

Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

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Cardiovascular risk management in COPD patients: impact of the new Dutch guideline

BJGP Open ◽

10.3399/bjgpopen20x101139 ◽

2020 ◽

pp. bjgpopen20X101139

Author(s):

Lonneke Maria Elisabeth Nies ◽

Looijmans I ◽

Rozendaal Rozendaal ◽

Brenda Baar ◽

Rimke C Vos ◽

...

Keyword(s):

Risk Assessment ◽

Primary Care ◽

High Risk ◽

Care Program ◽

Qualitative Risk Assessment ◽

Copd Patients ◽

Increased Risk ◽

The Impact ◽

Very High

Background: Patients with COPD have an independent increased risk of cardiovascular (CV) disease. CV-risk (CVR) assessment should be offered to all COPD-patients according to the new Dutch ‘CVR management’ (CVRM) guideline (May-2019). Aim: To evaluate the impact of this new guideline for the care of COPD-patients in primary care. Design and Setting: A retrospective study within five primary healthcare centres located in the Netherlands. Methods: In accordance with the guideline we estimated and categorized the CVR of all COPD-patients. Data from 2014–2019 were used for the qualitative risk assessment based on comorbidities, and the quantitative Systematic Coronary Risk Assessment (SCORE). In addition, we investigated the guideline-based follow-up. Results: Of the 391 COPD-patients, 84.1% (n=329) had complete data on CVR assessment: 90.3% (n=297) had a (very)-high risk and 9.7% (n=32) a low-to-moderate risk. Of the patients with (very)-high risk, 73.4% (n=218) received guideline-based follow-up (primary care: 95.4%, secondary care: 4.6%). In 15.9% (n=62) of all COPD-patients, the CVR profile was not measured and of the (very)-high-risk patients, 26.6% (n=79) was not enrolled in a CV-care program. Conclusion: Whereas in the majority of patients the CVR is already known, for one out of six COPD-patients this CVR still has to be assessed according to the recently updated guideline. Moreover, once a (very)-high risk has been assessed, as a consequence CV treatment of risk factors should be intensified in one out of four COPD-patients. Adherence to the new CVRM guideline could provide improvement in CVRM in more than a third of all COPD-patients.

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Integrated disease management improves one-year quality of life in primary care COPD patients: a controlled clinical trial

Primary Care Respiratory Journal ◽

10.3132/pcrj.2009.00003 ◽

2009 ◽

Vol 18 (3) ◽

pp. 171-176 ◽

Cited By ~ 52

Author(s):

Niels H Chavannesa ◽

Marlous Grijsen ◽

Marjan van den Akker ◽

Huub Schepers ◽

Maddy Nijdam ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Clinical Trial ◽

Disease Management ◽

Controlled Clinical Trial ◽

Integrated Disease Management ◽

Copd Patients ◽

One Year

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Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

10.21203/rs.2.17741/v3 ◽

2020 ◽

Author(s):

Eline Meijer ◽

Annelies E. van Eeden ◽

Annemarije L. Kruis ◽

Melinde R.S. Boland ◽

W. J.J. (Pim) Assendelft ◽

...

Keyword(s):

Primary Care ◽

Disease Management ◽

Usual Care ◽

Clinical Improvement ◽

Patient Characteristics ◽

Integrated Disease Management ◽

Copd Patients ◽

Treatment Type ◽

Post Hoc ◽

Over Time

Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

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Project CHAT: The Impact of a Brief Motivational Intervention for High-Risk Teens in Primary Care

PsycEXTRA Dataset ◽

10.1037/e679072007-001 ◽

2007 ◽

Author(s):

Elizabeth J. D'Amico ◽

Stefanie A. Stern ◽

Lisa S. Meredith ◽

Jeremy Miles

Keyword(s):

Primary Care ◽

High Risk ◽

Motivational Intervention ◽

Brief Motivational Intervention ◽

The Impact

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Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01213-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Eline Meijer ◽

Annelies E. van Eeden ◽

Annemarije L. Kruis ◽

Melinde R. S. Boland ◽

Willem J. J. Assendelft ◽

...

Keyword(s):

Disease Management ◽

Usual Care ◽

Clinical Improvement ◽

Integrated Disease Management ◽

Post Hoc Analysis ◽

Copd Patients ◽

Post Hoc

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Therapeutic itinerary of people with tuberculosis in face with their health needs

Escola Anna Nery ◽

10.1590/2177-9465-ean-2019-0034 ◽

2019 ◽

Vol 23 (3) ◽

Author(s):

Aliéren Honório Oliveira ◽

Antonio Germane Alves Pinto ◽

Maria do Socorro Vieira Lopes ◽

Tânia Maria Ribeiro Monteiro de Figueiredo ◽

Edilma Gomes Rocha Cavalcante

Keyword(s):

Primary Care ◽

Disease Management ◽

Qualitative Study ◽

Health Needs ◽

Smear Microscopy ◽

Structured Interviews ◽

X Ray ◽

Entrance Door ◽

One Year ◽

The Impact

Abstract Objective: To describe the therapeutic itinerary of people with tuberculosis in face of their health needs. Method: Descriptive, qualitative study. Semi-structured interviews were carried out with ten patients. Hermeneutic-dialectic method of analysis and concept of therapeutic itinerary as driver of the analysis. Results: Most had classic symptoms at the beginning, however there was a case with coughing for more than one year. Entrance door, access to diagnosis and treatment were predominant in Primary Care, through smear microscopy and X-ray; patients had to pay for exams. Decentralization of treatment for other services when necessary or by link with the professional. The patient followed the decisions of the professionals and the support of relatives; prejudice regarding the disease was noted. Conclusions and implications for practice: Fragility in disease management, importance of bonding and family. It should be considered the impact of the disease and the need to support patients to ensure continuity of care.

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