Active management boosts patient satisfaction with COPD care

By Joanna Lyford, Senior medwireNews Reporter

A disease management program (DMP) for chronic obstructive pulmonary disease (COPD) based on the Chronic Care Model leads to greater patient satisfaction with care than standard disease management, a randomized trial suggests.

The DMP emphasized the role of the primary care physician in coordinating care of patients with COPD, a feature that the researchers believe underpinned the greater patient satisfaction they observed.

The DMP was introduced in central Denmark in 2008 and is based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and Danish clinical guidelines.

General practitioner (GP) practices were randomly assigned to implement disease management in the standard way (control practices; n=21) or using an “active, structured” approach that included engagement of a local, esteemed opinion leader, regular meetings between GPs and experienced facilitators, reimbursement for GPs for undertaking home visits with the community nurse, and targeted support for patients suffering exacerbations (intervention practices; n=17). The researchers also recruited an external control group (n=25) involving practices from outside the intervention municipality, to account for a spillover effect to neighboring practices.

The study’s primary outcome was the patients’ assessment of their care, measured with the Patient Assessment of Chronic Illness Care (PACIC) instrument. A total of 744 patients completed the PACIC at both baseline and at 12 months and were included in the analysis.

Writing in BMC Family Practice, Margrethe Smidth (Aarhus University, Denmark) and colleagues report that mean total PACIC scores rose from 2.05 to 2.14 in the intervention group but decreased from 2.02 to 1.97 in the control group, resulting in a statistically significant difference between the two groups. Similarly, in the external control group the mean score fell from 1.92 to 1.87.

More detailed analysis of PACIC scores suggested that this result was driven by the intervention’s superiority in the domains of delivery system design/decision support and goal-setting, whereas there was no difference in the areas of patient activation, problem-solving, or follow-up/coordination.

“This finding indicates that the implementation of the DMP did not affect the way health professionals support patients in dealing with the challenges of living with COPD and the way they interact with other healthcare providers involved in the patient’s care,” remark the authors.

They say the finding highlights an area for future improvement and suggest that it may be too demanding for GPs to share care considerations with other health practitioners as well as the patients.

Nevertheless they conclude that, given the more positive evaluation patients gave of their care following the DMP implementation, “the present study supports the idea of active implementation strategies when implementing new healthcare programs.”

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