<p>Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD</p>

Abstract

Purpose: Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD. Methods: A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM. Results: Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57-70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1-3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up. Conclusion: Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.

Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis

“…For example, as expressed in the category “improving quality of care,” health care professionals now establish more contacts with other professionals working with patients with COPD at their health care center. Furthermore, considering the complexity of COPD management and the importance of an interdisciplinary treatment approach [ 2 , 55 ], if eHealth tools can facilitate interprofessional collaborations, eHealth could be used to tackle a key obstacle (low access to evidence-based care) to improving the quality of COPD services and care [ 56 , 57 ]. eHealth tools such as the COPD Web could be an essential means of reducing hierarchies, skepticism, and lack of knowledge about how other professions work and their roles in COPD management, both of which are known barriers to collegial and interprofessional collaboration [ 58 , 59 ].…”

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

“…COPD is character as a heterogeneous disease [29][30][31][32]. Phenotype is helpful to recognize the heterogeneity and understand the evolution of disease [30,32].…”

The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

“…COPD is character as a heterogeneous disease [28][29][30][31] . Phenotype is helpful to recognize the heterogeneity and understand the evolution of disease [29,31] .…”