A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

Abstract

BACKGROUND: A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China. METHODS: A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular followup. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits. RESULTS: After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1-21.9%, and awareness scores for COPD by 57.2% (P < .05 for all). CONCLUSIONS: The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC)

“…distress = presence of psychological distress. ing COPD and asthma, 16,48 metabolic syndrome, 49 kidney failure, 20 diabetes, 50 blood pressure control 51 and people with risk factors. 52 Interventions were based on different approaches, mainly self-management support and patient education.…”

“…For this reason, many chronic disease prevention and management (CDPM) programs have been designed with the aim of improving outcomes in these patients. CDPM programs targeting diabetes, [3][4][5][6][7] asthma, 8,9 heart diseases, [10][11][12] depression, [13][14][15] chronic obstructive lung disease (COPD), 16,17 obesity, 18,19 kidney disease, 20 dyslipidemia, 21 hypertension 22 and chronic pain 23 have been shown to be effective in improving outcomes such as hospital admissions, costs, adherence to medication, disease control, use of health services, quality of life and mortality. However, these studies were conducted in different settings and were based on single diseases.…”

Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review

“…Components of the reviewed trials are depicted in Table 2. The trials included different levels of education delivered using different methods such as telephone mentoring (Walters et al 2013;Jolly et al 2018); face-to-face sessions (Efraimsson et al 2008;Bischoff et al 2012;Taylor et al 2012;Lou et al 2015); or mix methods (McGeoch et al 2006;Zwar et al 2012;Mitchell et al 2014).…”

Research on Supportive Psychosocial, Drug Treatment, and Health Education Intervention and Health Management Model of Community-Residing Elderly Adults With Late Life Depression in Liaoning Province: A Protocol

“…In Western countries in the 1970s, health management, an important topic in the field of healthcare, developed rapidly and was successfully implemented for chronic conditions such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease (20)(21)(22). By combining information technology, geriatric medicine, and community medicine, health management has been used to strengthen the management of chronic diseases in the elderly, improve their lifestyle, and reduce mortality rates from disease (23).…”