ABSTRACT
OBJECTIVE: To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD). DESIGN: A 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. SETTING: Primary Care Centres in two Barcelona Health Areas and their referral hospitals. PARTICIPANTS: Patients with COPD selected by simple random sampling using any disease code corresponding to COPD. INTERVENTIONS: I1: 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 MEASUREMENTS: Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations. RESULTS: Of 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]). CONCLUSIONS: Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Aged , Female , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. METHODS/DESIGN: A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. DISCUSSION: The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
Subject(s)
Patient Care Management/organization & administration , Primary Health Care/methods , Pulmonary Disease, Chronic Obstructive/therapy , Disease Management , Evaluation Studies as Topic , Humans , Process Assessment, Health CareABSTRACT
Objetivo: Evaluar la efectividad de dos programas de gestión en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Diseño: Estudio de diseño cuasi-experimental para evaluar la efectividad de dos intervenciones (I1, I2) para la asistencia de pacientes con EPOC, tras un seguimiento medio de 31,2 meses. Emplazamiento: Centros de atención primaria de dos áreas sanitarias de Barcelona y sus hospitales de referencia. Participantes: Pacientes EPOC seleccionados por muestreo aleatorio simple en los que constara algún código correspondiente a EPOC. Intervenciones: I1: Programa de gestión integral que optimizaba y coordinaba los recursos. Se hizo formación y control de calidad de la espirometría. I2: Intervenciones aisladas, como el call-center. Compartían circuitos asistenciales y la historia clínica informatizada. Mediciones principales: variables de función pulmonar, gravedad, uso de inhaladores, estilos de vida, calidad de vida y exacerbaciones. Resultados: De los 393 pacientes evaluados al inicio, 120 y 104 (I1 e I2, respectivamente) realizaron la evaluación final. Con la I1 hubo una reducción de los pacientes fumadores (p = 0,034). En ambos grupos, la función pulmonar y la calidad de vida se mantuvieron y la disnea mostró un leve empeoramiento. El correcto uso de inhaladores aumentó, aunque solo alcanzó el 48 y el 61% con la I1 e I2, respectivamente. El porcentaje de pacientes exacerbados disminuyó con la I1 (respecto I2 [p < 0,001]) y el de ingresos hospitalarios por exacerbación disminuyó con la I2 (respecto I1 [p < 0,003]). Conclusiones: Ambas intervenciones consiguieron mejoras relevantes y el no empeoramiento global de una enfermedad crónica y progresiva como es la EPOC (AU)
Objective: To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD). Design: A 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 31.2 months. Setting: Primary Care Centres in two Barcelona Health Areas and their referral hospitals. Participants: Patients with COPD selected by simple random sampling using any disease code corresponding to COPD. Interventions: I1: 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 measurements: Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations. Results: Of 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]). Conclusions: Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD (AU)
Subject(s)
Humans , Male , Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Clinical Governance/organization & administration , Life Style , Quality of Life , Primary Health Care/organization & administration , Evaluation of the Efficacy-Effectiveness of Interventions , Follow-Up Studies , Spain/epidemiology , Spirometry/statistics & numerical data , Spirometry , Nebulizers and VaporizersABSTRACT
The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making).
Subject(s)
Primary Health Care , Pulmonary Disease, Chronic Obstructive/therapy , Age Distribution , Chronic Disease/epidemiology , Comorbidity , Consensus Development Conferences as Topic , Hospitalization/statistics & numerical data , Humans , National Health Programs , Patient Education as Topic , Practice Guidelines as Topic , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/prevention & control , Quality of Life , Spain/epidemiology , SpirometryABSTRACT
El envejecimiento de la población en los países occidentales conlleva un incremento de las enfermedades crónicas. Estas se manifiestan mediante la tríada edad, comorbilidad y polimedicación. La enfermedad pulmonar obstructiva crónica representa una de las causas más importantes de morbimortalidad, con una prevalencia en España del 10,2% en población de 40 a 80 años. En los últimos años ha pasado a definirse no solo como una enfermedad obstructiva pulmonar sino también como una enfermedad sistémica. Algunos aspectos destacan en su manejo: el tabaquismo, principal factor de riesgo, aun siendo evitable, es un problema de salud importante; cifras de infradiagnóstico muy importantes y escasa precisión diagnóstica, con inadecuado uso de la espirometría forzada; perfil de paciente crónico; agudizaciones que afectan a la supervivencia y provocan ingresos repetidos; movilización de numerosos recursos en salud; necesidad de plantear una atención integrada (educación sanitaria, rehabilitación, promoción del autocuidado e implicación del paciente en la toma de decisiones)(AU)
The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making)(AU)