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Care plans for acutely deteriorating COPD: a randomized controlled trial

Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

D McNamara

South Link Health Inc., Dunedin, New Zealand

F R Sutherland

Otago District Health Board, Dunedin, New Zealand

M W Tilyard

Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

D R Taylor

Respiratory Research Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand robin.taylor(stonebow.otago.ac.nz

Introduction: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent reason for admission to hospital and are responsible for the majority of the direct economic costs of treating COPD. Aims: To test whether an individualized care plan for patients experiencing acute exacerbations of COPD result in reduced health care utilization and improved quality of life for patients. Methods: Ninety-two patients with confirmed COPD were selected by general practitioners or district nurses, and randomly assigned to care plan or usual care groups. The care plan was developed in collaboration with general practitioners, secondary care specialists, specialist nurses, ambulance service providers and the after hours clinic. Patients were followed for 12 months, and the primary end-points were frequency of use of primary care services and hospital admissions. Results: There was no significant reduction in hospital admissions or improvement in quality of life in the group of patients who used the care plan compared to controls. The care plan group called out the ambulance service more frequently [2.8 (1.3, 4.3) versus 1.1 (0.7, 1.5) calls per 12 months; P = 0.03], and there was a trend towards greater use of oral prednisone [2.3 (1.4, 3.2) versus 1.3 (0.8, 1.8) courses per 12 months; P = 0.06]. Conclusion: In contrast to asthma, the provision of individualized self-management plans, whose content was enhanced to provide guidance to carers and health care professionals, did not reduce health care utilization or improve overall quality of life during acute exacerbations of COPD. Other strategies are required.

Key Words: COPD • exacerbations • self-management • case-management

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