Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study.

Autor: Meijer E; Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands. E.Meijer@lumc.nl., van Eeden AE; Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands., Kruis AL; Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands., Boland MRS; Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands., Assendelft WJJ; Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB, Nijmegen, Netherlands., Tsiachristas A; Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands.; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK., Rutten-van Mölken MPMH; Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands., Kasteleyn MJ; Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.; Department of Pulmonology, Leiden University Medical Centre, Leiden, PO Box 9600, 2300 RC, Leiden, Netherlands., Chavannes NH; Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
Jazyk: angličtina
Zdroj: BMC pulmonary medicine [BMC Pulm Med] 2020 Jun 18; Vol. 20 (1), pp. 176. Date of Electronic Publication: 2020 Jun 18.
DOI: 10.1186/s12890-020-01213-8
Abstrakt: Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.
Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.
Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).
Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.
Trial Registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010.
Databáze: MEDLINE
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