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

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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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/v1 ◽

2019 ◽

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 ◽

Chronic Obstructive ◽

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. 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

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

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-019-0119-9 ◽

2019 ◽

Vol 29 (1) ◽

Cited By ~ 6

Author(s):

Madonna Ferrone ◽

◽

Marcello G. Masciantonio ◽

Natalie Malus ◽

Larry Stitt ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Disease Management ◽

Integrated Disease Management ◽

Copd Patients ◽

The Impact

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Describing characteristics of a primary care COPD population receiving Integrated Disease Management and the durability of quality of life outcomes over time

10.1183/13993003.congress-2021.pa1015 ◽

2021 ◽

Author(s):

Jennifer DCruz ◽

Anna Hussey ◽

Madonna Ferrone ◽

Christopher Licskai

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Disease Management ◽

Integrated Disease Management ◽

Life Outcomes ◽

Quality Of Life Outcomes ◽

Over Time

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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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COPD integrated disease management, from controlled trial to real-world primary care; a cohort study

10.1183/13993003.congress-2020.3256 ◽

2020 ◽

Author(s):

Anna Hussey ◽

Kevin Wing ◽

Madonna Ferrone ◽

Christopher Licskai

Keyword(s):

Primary Care ◽

Cohort Study ◽

Disease Management ◽

Real World ◽

Controlled Trial ◽

Integrated Disease Management

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Effect of Timing of Fungicide Applications on Development of Rusts on Daylily, Geranium, and Sunflower

Plant Disease ◽

10.1094/pdis.2004.88.6.657 ◽

2004 ◽

Vol 88 (6) ◽

pp. 657-661 ◽

Cited By ~ 24

Author(s):

D. S. Mueller ◽

S. N. Jeffers ◽

J. W. Buck

Keyword(s):

Disease Management ◽

Effective Means ◽

Management Program ◽

Integrated Disease Management ◽

Lesion Development ◽

Application Timing ◽

Fungicide Efficacy ◽

Ornamental Crops ◽

Rust Pathogens ◽

Over Time

Integrated disease management should provide the most effective means of controlling rusts on ornamental crops over time, and fungicides are an important component of an integrated rust management program. Proper timing of fungicide applications is critical for effective disease management; however, information about application timing is lacking for rusts on ornamental crops. The objective of this study was to determine how fungicides affected rust development on daylily, geranium, and sunflower plants when applied several days before or after inoculation. Five fungicides registered for use against rusts on ornamental crops were evaluated: the strobilurin azoxystrobin; three sterol biosynthesis inhibiting fungicides—myclobutanil, propiconazole, and triadimefon; and the broad spectrum protectant chlorothalonil. All five fungicides significantly reduced lesion development by rust pathogens on daylily, geranium, and sunflower plants when these compounds were applied preventatively up to 15 days before inoculation and infection with a few exceptions (e.g., propiconazole on geranium and triadimefon on sunflower). Curative activity, which resulted from fungicide application after inoculation, was observed for the three rusts with some products (azoxystrobin on all three plants and myclobutanil, propiconazole, and triadimefon on geranium) when applied up to 7 days postinoculation. In general, fungicide efficacy with several of the products decreased as the time from application to inoculation (preventative activity) or inoculation to application (curative activity) increased.

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Evidence of Pent-Up Demand for Care After Medicaid Expansion

Medical Care Research and Review ◽

10.1177/1077558717697014 ◽

2017 ◽

Vol 75 (4) ◽

pp. 516-524 ◽

Cited By ~ 11

Author(s):

Angela R. Fertig ◽

Caroline S. Carlin ◽

Scott Ode ◽

Sharon K. Long

Keyword(s):

Primary Care ◽

Emergency Department ◽

Disease Management ◽

Emergency Department Visit ◽

Claims Data ◽

Office Visit ◽

Medicaid Expansion ◽

Management Plans ◽

Over Time

We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota’s 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees. The pattern of utilization suggests that the newly insured are connecting with primary care after the 2014 Medicaid expansion and, unlike ongoing Medicaid enrollees; the newly insured have a declining reliance on the emergency department over time.

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OP0279 THE IMPACT OF A REFERRAL STRATEGY FOR AXIAL SPONDYLOARTHRITIS: 12 MONTHS FOLLOW-UP OF PATIENT REPORTED OUTCOMES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6090 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 174.2-174

Author(s):

M. J. Abdelkadir ◽

M. Kuijper ◽

C. Appels ◽

A. Spoorenberg ◽

J. Hazes ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Axial Spondyloarthritis ◽

Control Group ◽

P Value ◽

Patient Reported ◽

Referral Strategy ◽

And Control ◽

The Impact ◽

Over Time

Background:Early recognition of axial spondyloarthritis (axSpA) patients is difficult for general practitioners within the large amount of chronic low back pain (CLBP) patients1. As a result, several referral strategies have been developed to help physicians identify patients at risk for axSpA. Most referral strategies were developed in secondary care patients with no available data on their impact. The only referral strategy that was developed and validated in primary CLBP patients is the Case Finding Axial Spondyloarthritis (CaFaSpA) strategy, but required an impact analysis before implementation in daily clinical practice2-3.Objectives:The purpose of this study was to assess the impact of using the CaFaSpA referral strategy on patient reported outcome outcomes (PROs) in primary care patients with CLBP at risk for axSpA.Methods:A clustered randomized controlled trial was performed in a primary care setting in the Netherlands. (ClinicalTrials.gov Identifier:NCT01944163). Each cluster contained the general practices from a single primary care practice and their included patients. Clusters were randomized to either the intervention (use of CaFaSpA referral strategy) or the control group (usual care). Primary outcome was disability after 12 months. Secondary outcome was quality of life, pain and fatigue after 12 months. A linear mixed-effects model was used to explore the effects over time according to intention to treat analysis.Results:In total 679 patients were included within 93 GP clusters. Sixty-four percent of our study population were female and mean age was 36 (7.5) years. Overall RMDQ reduced over time both in the intervention and control group (figure 1). The difference in decrease was not statically significant between the groups (p-value 0.81).Figure 1.Estimated mean RMDQ scores over time for the overall intervention and usual care group.EQ-5D increased by 0.03 after 12 months within the intervention group and 0.01 in the control group (not significant) (table 1). The decrease in pain and fatigue did not differ significantly between the intervention and control group.Table 1.Mean change in PROs after 12 months in the intervention and control groupPROsInterventionUsual careBaseline12 monthsp-valueBaseline12 monthsp-valueEQ-5D mean (SD)0.69 (0.26)0.72 (0.27)0.140.72 (0.24)0.73 (0.25)0.53VAS-pain mean (SD)5.03 (2.42)4.68 (2.69)0.074.96 (2.42)4.55 (2.69)0.02VAS-fatigue mean (SD)5.19 (2.50)5.01 (0.21)0.355.23 (2.45)4.86 (2.73)0.04Conclusion:Although the functional disability due to pain reduces over time, there was no positive effect by referring based on the CaFaSPA model. Further data on PROMs for the axSpA patients are under investigation.References:[1]Jois RN et al. Rheumatology (Oxford) 2008;47:1364-1366.[2]van Hoeven L et al. PLoS One 2015; 22;10(7):e0131963.[2]Moons KG et al. Heart 2012;98(9):691-8.Disclosure of Interests:None declared

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