Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases

Scand J Prim Health Care. 2007 Sep;25(3):186-92. doi: 10.1080/02813430701573943.


Objective: To investigate the effect of a primary care model for COPD on process of care and patient outcome.

Design: Controlled study with delayed intervention in control group.

Setting: The GP delegates tasks to a COPD support service (CSS) and a practice nurse. The CSS offers logistic support to the practice through a patient register and recall system for annual history-taking and lung function measurement. It also forms the link with the chest physician for diagnostic and therapeutic advice. The practice nurse's most important tasks are education and counselling.

Subjects: A total of 44 practices (n =22 for intervention and n =22 for control group) and 260 of their patients > or = 40 years with obstructive lung diseases.

Results: Within the intervention group planned visits increased from 16% to 44% and from 19% to 25% in the control condition (difference between groups p =0.014). Annual lung function measurement rose from 17% to 67% in the intervention and from 11% to 18% in the control group (difference between groups p =0.001). Compared with control, more but not statistically significant smokers received periodic advice to quit smoking (p =0.16). At baseline 41% of the intervention group were using their inhalers correctly and this increased to 54% after two years; it decreased in the control group from 47 to 29% (difference between groups p =0.002). The percentage of patients without exacerbation did not change significantly compared with the control condition. The percentage of the intervention group not needing emergency medication rose from 79% to 84% but decreased in the controls from 81 to 76% (difference between groups p =0.08).

Conclusion: Combining different disciplines in one model has a positive effect on compliance with recommendations for monitoring patients, and improves the care process and some patient outcomes.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asthma / drug therapy
  • Asthma / nursing
  • Asthma / therapy*
  • Delivery of Health Care, Integrated
  • Family Practice / organization & administration*
  • Guideline Adherence
  • Humans
  • Middle Aged
  • Netherlands
  • Outcome Assessment, Health Care
  • Patient Care Planning
  • Primary Health Care / organization & administration*
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / nursing
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Referral and Consultation
  • Smoking Cessation
  • Surveys and Questionnaires