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- Title
Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial.
- Authors
Zwar, Nicholas A.; Bunker, Jeremy M.; Reddel, Helen K.; Dennis, Sarah M.; Middleton, Sandy; van Schayck, Onno C. P.; Crockett, Alan J.; Hasan, Iqbal; Hermiz, Oshana; Vagholkar, Sanjyot; Wei Xuan; Marks, Guy B.; Xuan, Wei
- Abstract
<bold>Background: </bold>Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm.<bold>Objectives: </bold>To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD.<bold>Methods: </bold>A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use.<bold>Results: </bold>Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21; P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes.<bold>Conclusion: </bold>Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.
- Subjects
OBSTRUCTIVE lung disease treatment; EARLY medical intervention; FAMILY medicine; NURSING; QUALITY of life; RANDOMIZED controlled trials; INFLUENZA prevention; OBSTRUCTIVE lung disease diagnosis; NURSING education; COMPARATIVE studies; HEALTH attitudes; HEALTH care teams; IMMUNIZATION; OBSTRUCTIVE lung diseases; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; NURSES; CONTINUING education of nurses; PHYSICIANS; QUESTIONNAIRES; RESEARCH; RESPIRATORY measurements; SMOKING; CONTINUING medical education; OCCUPATIONAL roles; EVALUATION research; VITAL capacity (Respiration); BLIND experiment
- Publication
Family Practice, 2016, Vol 33, Issue 6, p663
- ISSN
0263-2136
- Publication type
journal article
- DOI
10.1093/fampra/cmw077