Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial

Jenifer Liang; Michael J Abramson; Grant Russell; Anne E Holland; Nicholas A Zwar; Billie Bonevski; Ajay Mahal; Paula Eustace; Eldho Paul; Kirsten Phillips; Narelle S Cox; Sally Wilson; Johnson George

doi:10.1183/13993003.01530-2018

Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial

Eur Respir J. 2019 Apr 25;53(4):1801530. doi: 10.1183/13993003.01530-2018. Print 2019 Apr.

Authors

Jenifer Liang¹, Michael J Abramson², Grant Russell³, Anne E Holland⁴, Nicholas A Zwar^{5

6}, Billie Bonevski⁷, Ajay Mahal⁸, Paula Eustace⁹, Eldho Paul², Kirsten Phillips¹⁰, Narelle S Cox¹¹, Sally Wilson^{1

12}, Johnson George^{13

2}

Affiliations

¹ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
² Dept of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ Southern Academic Primary Care Research Unit, Dept of General Practice, Monash University, Melbourne, Australia.
⁴ Discipline of Physiotherapy, La Trobe University, Alfred Health, and Institute for Breathing and Sleep, Melbourne, Australia.
⁵ School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
⁶ Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
⁷ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
⁸ The Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
⁹ Eastern Melbourne PHN (EMPHN), Melbourne, Australia.
¹⁰ Lung Foundation Australia (LFA), Milton, Australia.
¹¹ Discipline of Physiotherapy, La Trobe University and Institute for Breathing and Sleep, Melbourne, Australia.
¹² Dept of Infrastructure Engineering, The University of Melbourne, Melbourne, Australia.
¹³ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia johnson.george@monash.edu.

PMID: 30792342
DOI: 10.1183/13993003.01530-2018

Abstract

We evaluated the effectiveness of an interdisciplinary, primary care-based model of care for chronic obstructive pulmonary disease (COPD).A cluster randomised controlled trial was conducted in 43 general practices in Australia. Adults with a history of smoking and/or COPD, aged ≥40 years with two or more clinic visits in the previous year were enrolled following spirometric confirmation of COPD. The model of care comprised smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase). Main outcomes included changes in St George's Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), dyspnoea, smoking abstinence and lung function at 6 and 12 months.We identified 272 participants with COPD (157 intervention, 115 usual care); 49 (31%) out of 157 completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ at 6 months (adjusted between-group difference 2.45 favouring intervention, 95% CI -0.89-5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ in those receiving the full intervention compared to usual care (difference 5.22, 95% CI 0.19-10.25). No statistically significant differences were observed in change in CAT, dyspnoea, smoking abstinence or lung function.No significant evidence was found for the effectiveness of this interdisciplinary model of care for COPD in primary care over usual care. Low uptake was a limitation.

Publication types

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

MeSH terms

Aged
Female
General Practice
Humans
Male
Middle Aged
Patient Care Team*
Primary Health Care*
Pulmonary Disease, Chronic Obstructive / therapy*
Treatment Outcome