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An expert‐supported monitoring system for patients with chronic obstructive pulmonary disease in general practice: results of a cluster randomised controlled trial
Author(s) -
Bemt Lisette,
Schermer Tjard R J,
Smeele Ivo J M,
Boonmande Winter Leandra J M,
Boxem Ton,
Denis Joke,
GrootensStekelenburg Joke G,
Grol Richard P T M,
Weel Chris
Publication year - 2009
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2009.tb02777.x
Subject(s) - medicine , copd , quality of life (healthcare) , physical therapy , randomized controlled trial , cluster randomised controlled trial , pulmonary disease , disease management , emergency medicine , intensive care medicine , disease , nursing , parkinson's disease
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: www.clinicaltrials.gov NCT00542061.