Effects of an integrated care intervention on risk factors of COPD readmission.

Abstract

UNLABELLED:

An integrated care intervention including education, coordination among levels of care, and improved accessibility, reduced hospital readmissions in chronic obstructive pulmonary disease (COPD) after 1 year. This study analyses the effectiveness of this intervention in terms of clinical and functional status, quality of life, lifestyle, and self-management, under the hypothesis that changes in these factors could explain the observed reduction in readmissions. A total of 113 exacerbated COPD patients (14% female, mean (SD) age 73(8) years, FEV(1) 1.2(0.5) l) were recruited after hospital discharge in Barcelona, Spain, and randomly assigned (1:2) to integrated care (IC) (n=44) or usual care (UC) (n=69). The intervention consisted of an individually tailored care plan at discharge shared with the primary care team and access to a specialized case manager nurse through a web-based call centre. After 1 year of intervention, subjects in the intervention group improved body mass index by 1.34 kg/m(2). Additionally, they scored better in self-management items: COPD knowledge 81% vs. 44%, exacerbation identification 85% vs. 22%, exacerbation early treatment 90% vs. 66%, inhaler adherence 71 vs. 37%, and inhaler correctness 86 vs. 24%. There were no differences in the evolution of dyspnea, lung function, quality of life scores, lifestyle factors, or medical treatment.

CONCLUSIONS:

This IC trial improved disease knowledge, and treatment adherence, after 1 year of intervention, suggesting that these factors may play a role in the prevention of severe COPD exacerbations triggering hospital admissions.

• Authors: Judith Garcia-Aymerich, Carme Hernandez, Albert Alonso, Alejandro Casas, Robert Rodriguez-Roisin, Josep M Anto, Josep Roca
• Journal: Respiratory medicine (Respir Med) Vol. 101 Issue 7 Pg. 1462-9 (Jul 2007) ISSN: 0954-6111 [Print] England
• PMID: 17339106 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Carbon Dioxide
• Oxygen

Topics

• Aged
• Body Mass Index
• Carbon Dioxide (blood)
• Delivery of Health Care, Integrated (methods)
• Female
• Follow-Up Studies
• Forced Expiratory Volume
• Health Knowledge, Attitudes, Practice
• Hospitalization
• Humans
• Life Style
• Male
• Oxygen (blood)
• Partial Pressure
• Patient Readmission
• Patient Satisfaction
• Pulmonary Disease, Chronic Obstructive (physiopathology, prevention & control, rehabilitation)
• Quality of Life
• Risk Factors
• Self Care
• Spain
• Vital Capacity