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Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial
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Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial
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Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial
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Journal Article
Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial
2015
Overview
Background:
Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level.
Aims:
The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients.
Methods:
From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (
n
=76, age 73 (8) years, forced expiratory volume during the first second, FEV
1
41(19) % predicted) or usual care (
n
=84, age 75(9) years, FEV
1
44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient’s empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years.
Results:
IC enhanced self-management (
P
=0.02), reduced anxiety–depression (
P
=0.001) and improved health-related quality of life (
P
=0.02). IC reduced both ED visits (
P
=0.02) and mortality (
P
=0.03) but not hospital admission. No differences between the two groups were seen after 6 years.
Conclusion:
The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force.
Chronic obstructive pulmonary disease: Investigating integrated care
Community-based integrated care (IC) for chronic obstructive pulmonary disease (COPD) improves outcomes but does not reduce hospitalization. Spanish researchers led by Carme Hernández at the University of Barcelona conducted a randomized controlled trial to explore the effectiveness of a community-based IC service in preventing hospitalizations and emergency department visits. The service consisted of assessment and education, individualized care plans, call center access and coordination between different levels of care. Seventy-six stable frail COPD patients received the IC intervention for 12 months, while 84 received usual care. Hospital admissions, emergency department visits and mortality were then monitored for six years after return to normal care. The intervention improved clinical outcomes and decreased emergency department visits, but did not reduce hospital admissions. Patient risk analysis and workforce preparation were identified as key requirements for developing IC services.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Aged
/ Chronic obstructive pulmonary diseases
/ Control de qualitat de l'assistència mèdica
/ Emergency Service, Hospital - statistics & numerical data
/ Female
/ Hospitalization - statistics & numerical data
/ Humans
/ Malalties pulmonars obstructives cròniques
/ Male
/ Medicine
/ Patient Care Team - organization & administration
/ Pneumology/Respiratory System
/ Pulmonary Disease, Chronic Obstructive - mortality
