COPD Patient Quality of Life Improved by Integrated Disease Management

Integrated disease management plans can improve the quality of life of patients with chronic obstructive pulmonary disease (COPD), according to a new report.

Investigators from Canada designed an integrated disease management plan in order to evaluate if such a plan high-risk COPD patients would reduce urgent primary care visits or improve their quality of life. Over the course of a year, 168 COPD patients—described by the investigators as high-risk and exacerbation prone—were randomized to either receive an integrated disease management course provided by a certified respiratory educator and a physician; or they received usual care from a physician.

Those in the integrated disease management program received care management, self-management education as well as skills training. The management plans can be a transformative approach for individualized medicine, investigators explained, and these plans have previously been defined as “a group of coherent interventions designed to prevent or manage one or more chronic conditions using a systematic, multidisciplinary approach, and potentially employing multiple treatment modalities.”

In this study, the integrated team included certified respiratory educators, all of whom were regulated healthcare professionals whose experience included patient counseling and asthma care.

The study authors noted the majority of COPD patients are managed by their primary care physicians on an “as-needed” or “needs to be assessed” basis, despite the challenges of COPD and its comorbidities.

About half of their study participants were women and the mean age was 68 years. The study visits were the same in the control and intervention group and were measured at baseline, 3, 6, and 9 months, with a close-out visit at 12 months.

“We think this study and the Best Care program has the potential to completely change how care is provided to patients with COPD,” study author Christopher Licskai, BSc, MD, told MD Magazine®. “We are looking for innovations that transform health care delivery.”

Licskai said the team’s most surprising finding was the impact that the intervention had on the patients’ quality of life. For the patients in the intervention group, quality of life improved significantly from 22.6 to 14.8 on the COPD Assessment Test. For the patients in the usual care/ primary management group, scores on that scale worsened from 19.3 to 22.0.

Other measures during the study showed differential improvements in favor of the integrated disease management course, such as the Clinical COPD Questionnaire (measuring 1.29), Bristol Knowledge Questionnaire (29.6%), and FEV₁ (measured at 100 mL).

Compared to the usual care group, those treated with the integrated method had significantly fewer COPD exacerbations, or required an urgent primary care visit for COPD, or had an emergency department visit.

Licskai was surprised during the course of the study of how well providers came together “to create high-performing health teams.”

While there was success using the intervention, the study authors wrote that because of its complexity, they were unable to identify the specific intervention(s) that led to the improved quality of life. They hypothesized that regular, clinical review and self-management action plans were successful, and therefore helped to improve quality of life.

They also reported the mental status of the patients, which is another contributing factor on quality of life improvements. Easier access to a certified respiratory educator may have also played a factor. With less COPD exacerbations, they concluded, quality of life can further improve.

The study, “The impact of integrated disease management in high-risk COPD patients in primary care,” was published online in Primary Care Respiratory Medicine.