An expert-supported monitoring system for patients with chronic obstructive pulmonary disease in general practice: results of a cluster randomised controlled trial

Med J Aust. 2009 Sep 7;191(5):249-54.


Objective: To investigate the long-term effectiveness of a general practice monitoring system with respiratory expert recommendations for general practitioners' management of patients with chronic obstructive pulmonary disease (COPD), compared with usual care.

Design, settings and participants: A multicentre randomised controlled trial of patients with COPD, clustered by general practices; 200 participants were recruited to maintain at least 75 participants per group for analysis. The trial took place from July 2005 to February 2008 in the south-western region of the Netherlands.

Intervention: Ongoing half-yearly monitoring of COPD patients with respiratory expert recommendations for the GP was compared with usual care.

Main outcome measures: Primary outcome - Chronic Respiratory Questionnaire (CRQ) score; secondary outcomes - CRQ domain scores, generic health-related quality of life (Short-Form 12 and EuroQol-5D), breathlessness (Modified Medical Research Council score), exacerbations, and decline in forced expiratory volume in 1 second. A detailed process evaluation was performed along with the trial.

Results: Data from 170 participants were analysed. Based on repeated measurement analyses, the additional gain in CRQ score during follow-up was 0.004 points for monitoring compared with usual care (95% CI, - 0.172 to 0.180). Also, no important differences between monitoring and the usual care group were found for secondary outcomes. Half the monitoring visits resulted in disease management recommendations by a respiratory expert, and 46% of these recommendations were implemented by the GPs. Patient adherence to lifestyle recommendations was low.

Conclusion: An expert-supported monitoring system for patients with COPD was not clinically effective. As patients had a pre-existing entry in the monitoring system, the population may be well regulated, with reduced room for improvement.

Trial registration: NCT00542061.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cluster Analysis
  • Disease Progression
  • Family Practice / methods*
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / physiology*
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Netherlands
  • Patient Compliance / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Referral and Consultation*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Time Factors
  • Vital Capacity / physiology*

Associated data