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Providing patients with reviews of evidence about COPD treatments: a controlled trial of outcomes
M Harris
Department of Medicine, The University of Adelaide, Australia; (BTech, Grad Dip Inf Man/Lib, MEd), melanie.harris{at}rgh.sa.gov.au
B J Smith
Department of Medicine, The University of Adelaide, Australia; (BTech, Grad Dip Inf Man/Lib, MEd), Clinical Epidemiology Unit Respiratory, The Queen Elizabeth Hospital and Health Services, Adelaide, Australia, Medicine and Sleep Disorders Unit, The Queen Elizabeth Hospital and Health Services, Adelaide, Australia
A Veale
Department of Medicine, The University of Adelaide, Australia; (BTech, Grad Dip Inf Man/Lib, MEd), Medicine and Sleep Disorders Unit, The Queen Elizabeth Hospital and Health Services, Adelaide, Australia
A Esterman
School of Nursing and Midwifery, University of South Australia, Adelaide, Australia
P A Frith
Respiratory Services, Flinders Medical Centre and Repatriation General Hospital at Daw Park, Australia
P Selim
Clinical Epidemiology Unit Respiratory, The Queen Elizabeth Hospital and Health Services, Adelaide, Australia
Studies in many countries have identified gaps between what is known from research evidence and what is done in clinical practice. Merely making research evidence available to practitioners does not cause much change in their behaviour, and researchers are now looking for more effective ways to improve the implementation of evidence. We report outcomes at three months of a parallel group trial of an evidence based patient manual designed to improve implementation of evidence by the patient’s doctors. The patient manual was produced with extensive patient and professional input. It contained summaries of the evidence for treatments used in COPD (chronic obstructive pulmonary disease) and prompted discussion of evidence with doctors. Participants in the intervention arm of the trial (n - 125) were supplied with the manual and participants in the control arm (n - 124) were supplied with a pamphlet about COPD produced by the Australian Lung Foundation. The primary outcome measure (rates of current influenza vaccination and bone density testing) was an indicator of evidence based management of COPD. Secondary outcomes were quality of life (mastery component), satisfaction with information, communication with usual doctor, and anxiety. At three months no pattern of benefit in outcome measures was found for either group. Process measures showed high levels of personal use of the manual but progression to conversations with doctors for fewer than half of participants, and little treatment change. The findings highlight the difficulties of promoting changes in health behaviour and show that even when all stakeholders are consulted success is not guaranteed. Further research is required to identify those patients most likely to use manuals such as the one reported here, and how to make patient mediated interventions more effective for a greater proportion of the target population.
Key Words: controlled clinical trial • chronic obstructive • evidence-based medicine • patient participation • pulmonary disease
References
- Buchan H. Gaps between best evidence and practice: causes for concern . Med J Aust 2004; 180: S48-S49 .[Medline]
[Order article via Infotrieve]
- Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care . Lancet 2003; 362: 1225-1230 .[CrossRef][Medline]
[Order article via Infotrieve]
- Grimshaw JM, Eccles MP, Walker AE, Thomas RE. Changing physicians’ behavior: what works and thoughts on getting more things to work . J Contin Educ Health Prof 2002; 22: 237-243 .[CrossRef][Medline]
[Order article via Infotrieve]
- Tomlin Z, Humphrey C, Rogers S. General practitioners’ perceptions of effective health care . Br Med J 1999; 318: 1532-1535 .[Abstract/Free Full Text]
- Freeman AC, Sweeney K. Why general practitioners do not implement evidence: qualitative study . Br Med J 2001; 323: 1100-1102 .[Abstract/Free Full Text]
- Holmes-Rovner M, Llewellyn-Thomas H, Entwistle V, Coulter A, O’Connor A, Rovner DR. Patient choice modules for summaries of clinical effectiveness: a proposal . Br Med J 2001; 322: 664-667 .[Free Full Text]
- Murray CJL, Lopez ADE. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press , 1996.
- Frith P, McKenzie D, Pierce R. Management of chronic obstructive pulmonary disease in the twenty-first century . Intern Med J 2001; 31: 508-511 .[CrossRef][Medline]
[Order article via Infotrieve]
- Cydulka RK, Rowe BH, Clark S, Emerman CL, Camargo CA Jr, MARC Investigators. Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration . J Am Geriatr Soc 2003; 51: 908-916 .[CrossRef][Medline]
[Order article via Infotrieve]
- Rudolf M. The reality of drug use in COPD: the European perspective . Chest 2000; 117: 29S-32S .[Abstract/Free Full Text]
- NHMRC. How to present the evidence for consumers: preparation of consumer publications. NHMRC , 2000.
- Poole PJ, Chacko E, Wood-Baker RW, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease . Cochrane Database of Systematic Reviews 2000; (4).
- Smith BJ, Phillips PJ, Heller RF. Asthma and chronic obstructive airway diseases are associated with osteoporosis and fractures: a literature review . Respirology 1999; 4: 101-109 .[CrossRef][Medline]
[Order article via Infotrieve]
- The Australian Lung Foundation. COPD - Chronic Bronchitis & Emphysema. The Australian Lung Foundation , 2002.
- Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the diagnosis, management, and prevention of COPD. National Institutes of Health, National Heart Lung and Blood Institute , 2001.
- Hulscher ME, Laurant MG, Grol RP. Process evaluation on quality improvement interventions . Qual Saf Health Care 2003; 12: 40-46 .[Abstract/Free Full Text]
- Black N. Why we need observational studies to evaluate the effectiveness of health care . Br Med J 1996; 312: 1215-1218 .[Free Full Text]
- McKee M, Britton A, Black N, McPherson K, Sanderson C, Bain C. Methods in health services research. Interpreting the evidence: choosing between randomised and non-randomised studies . Br Med J 1999; 319: 312-315 .[Free Full Text]
- Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease . Thorax 1987; 42: 773-778 .[Abstract/Free Full Text]
- Hermiz O, Comino E, Marks G, Daffurn K, Wilson S, Harris M. Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease . Br Med J 2002; 325: 938-938 .[Abstract/Free Full Text]
- Meakin R, Weinman J. The ‘Medical Interview Satisfaction Scale’ (MISS-21) adapted for British general practice . Fam Pract 2002; 19: 257-263 .[Abstract/Free Full Text]
- Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) . Br J Clin Psychol 1992; 31: 301-306 .[Medline]
[Order article via Infotrieve]
- SEIFA 2001 Australian Bureau of Statistics. ABS , 2004.
- Jorm AF, Griffiths KM, Christensen H, Korten AE, Parslow RA, Rodgers B. Providing information about the effectiveness of treatment options to depressed people in the community: a randomized controlled trial of effects on mental health literacy, help-seeking and symptoms . Psychol Med 2003; 33: 1071-1079 .[CrossRef][Medline]
[Order article via Infotrieve]
- Robinson A, Thomson R. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools . Qual Health Care 2001; 10: i34-i38 .[Abstract/Free Full Text]
- Stapleton H, Kirkham M, Thomas G. Qualitative study of evidence based leaflets in maternity care . Br Med J 2002; 324: 639-639 .[Abstract/Free Full Text]
- Kennedy A, Robinson A, Hann M, Thompson D, Wilkinn D. A cluster-randomised controlled trial of a patient-centred guidebook for patients with ulcerative colitis: effect on knowledge, anxiety and quality of life . Health Soc Care Commun 2003; 11: 64-72 .
- Macfarlane J, Holmes W, Gard P, Thornhill D, Macfarlane R, Hubbard R. Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet . Br Med J 2002; 324: 91-94 .[Abstract/Free Full Text]
- Jones RCM, Hyland ME, Hanney K, Erwin J. A qualitative study of compliance with medication and lifestyle modification in chronic obstructive pulmonary disease (COPD) . Primary Care Respiratory Journal 2004; 13: 149-154 .[Medline]
[Order article via Infotrieve]
- Monninkhof EM, van der Valk PD, van der Palen Jet al. Self-management education for chronic obstructive pulmonary disease . Cochrane Database of Systematic Reviews 2003; (1) CD002990.
- van Bokhoven MA, Kok G, van der Weijden T. Designing a quality improvement intervention: a systematic approach . Qual Saf Health Care 2003; 12: 215-220 .[Abstract/Free Full Text]
- Flottorp S, Oxman AD. Identifying barriers and tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods . BMC Health Serv Res 2003; 3: 3-3 .[CrossRef][Medline]
[Order article via Infotrieve]
Chronic Respiratory Disease, Vol. 3, No. 3,
133-140 (2006)
DOI: 10.1191/1479972306cd112oa
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