Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial

Abstract

We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for chronic obstructive pulmonary disease (COPD).A cluster randomised controlled trial was conducted in 43 general practices in Australia. Adults with a history of smoking and/or COPD, aged ≥40 years with two or more clinic visits in the previous year were enrolled following spirometric confirmation of COPD. The model of care comprised smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase). Main outcomes included changes in St George's Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), dyspnoea, smoking abstinence and lung function at 6 and 12 months.We identified 272 participants with COPD (157 intervention, 115 usual care); 49 (31%) out of 157 completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at 6 months (adjusted between-group difference 2.45 favouring intervention, 95% CI –0.89–5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ in those receiving the full intervention compared to usual care (difference 5.22, 95% CI 0.19–10.25). No statistically significant differences were observed in change in CAT, dyspnoea, smoking abstinence or lung function.No significant evidence was found for the effectiveness of this interdisciplinary model of care for COPD in primary care over usual care. Low uptake was a limitation.

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“…Our findings resonate with ideas around needing more tailored interventions for people with frailty 76 and respiratory disease, 77 thinking creatively about engagement with exercise-based interventions, 78 and taking integrated approaches to support the maintenance of physical and mental capacities in an aging population. 79 Recent examples within wider respiratory care include interdisciplinary models of primary care for people with COPD, 80 integrated respiratory and palliative care services for chronic breathlessness, 81 and rehabilitation for people with both respiratory and heart disease. 82 As research specifically with people with COPD and frailty increases, 50,54 this type of complex interventional work will be a priority.…”

Improving Chronic Obstructive Pulmonary Disease (COPD) Symptoms Using a Team-Based Approach

“…However, only a few trials directly demonstrated reduced hospitalization or rehospitalization; most have concentrated on other outcome measurements including quality of life and symptom improvement. 6,7,[17][18][19] The recent evidence of the integrated care management approach further supports the benefit of a multidisciplinary team to reduce ED visits and hospital admissions. 20 The streamlined unified meaningfully managed interdisciplinary team (SUMMIT) trial protocol shows further interest in the multidisciplinary approach to care in an urban homelessness setting; results of the trial are not yet available.…”

“…The inclusion of a physical therapist, pharmacist, psychologist, dietitian, exercise specialists, and social workers varied by study and location. 7,17,22,23 There is no consensus agreement regarding the ideal makeup of a COPD team despite the multiple studies that have been conducted. Regardless of the disciplines involved, teams should establish interdependence among the members where the treatment plan and patient-specific goals combines the expertise of the individual disciplines involved.…”

“…Previous literature has demonstrated the impact of a holistic, team approach for COPD management and beneficial outcomes on patient outcomes. 6,7 Studies by Koff and colleagues 6 and Liang and colleagues 7 demonstrated multidisciplinary care resulted in improved symptoms and quality of life while also decreasing overall health care expenditure compared with standard of care (ie, primary care provider only). This study evaluated the effectiveness of a teambased approach to improving patients' COPD management in a rural primary care clinic in Appalachia.…”

Delivering high value therapies in COPD: the secret is in the marketing

“…In this issue of the European Respiratory Journal, LIANG et al [5] present the results of a cluster randomised trial undertaken in primary care in Australia which investigated the effectiveness of an interdisciplinary bundle of interventions, comprising smoking cessation support, home medicines review by a pharmacist, and a home-based pulmonary rehabilitation programme (termed the "RADICALS model of care"). They used a case-finding approach to identify potential patients based on a smoking history on general practitioner (GP)'s records who, along with those with an existing coded diagnosis, were then eligible for the trial if baseline spirometry fulfilled diagnostic criteria for COPD.…”