Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD⁺): a randomised controlled trial

Abstract

We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63-0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54-0.88). Fewer intervention patients died (21 36) (HR 0.56, 95% CI 0.32-0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.

Three-Year Hospitalization and Mortality in Elderly Smokers with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure

“…Comorbidities increase the risk of hospitalization and death in both COPD and CHF [16,17]. There is preliminary evidence that aggressive search and treatment of concomitant chronic diseases in patients hospitalized because of a COPD exacerbation may be associated with reduced mortality and further hospitalizations and mortality [18].…”

Chronic Respiratory Abnormalities in the Multi-Morbid Frail Elderly

“…Ongoing multidisciplinary hospital and home base management programs suggest that a holistic integrated approach might improve quality of life and reduce admissions and duration of stay at the hospital, and possibly death in these multimorbid patients 93,94 . and non-financial support from Takeda, grants, personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Novartis, personal fees and non-financial support from Pearl Therapeutics, grants, personal fees and non-financial support from Menarini, personal fees and non-financial support from Mundipharma, personal fees from Kyorin, personal fees from Bayer, grants, personal fees and non-financial support from Laboratori Guidotti, personal fees and non-financial support from Boston Scientific, grants, personal fees and non-financial support from Almirall, personal fees from Zambon, grants from Pfizer, grants from Dompè, grants from Malesci, grants from Biofutura Italia, grants from Vree Health Italia, outside the submitted work.…”

Serotonergic antidepressants in COPD: beneficial or harmful?

“…Poor adherence to inhaled corticosteroids [17] Benzodiazepines [22] Opioids [23] Antidepressants [24,27] older adults without depression. In a similar vein, a multicomponent, case manager-led intervention [32] included an action plan for the management of acute exacerbation of COPD. This case manager intervention did not reduce the frequency of emergency department visits or hospital admissions but reduced the mortality rate by almost half compared to usual care [32].…”