Department of Respiratory Medicine, Repatriation Hospital, Adelaide, Australia.
J Physiother. 2012;58(1):60. doi: 10.1016/S1836-9553(12)70076-0.
In patients with COPD, does an action plan (AP) with support from a case manager lead to earlier contact with healthcare professionals and faster recovery from an exacerbation?
Randomised, controlled trial with concealed allocation. Patients were unaware of the study aims.
8 regional hospitals and 5 general practices in Europe.
Adults with COPD, aged > 40 years, with a substantial smoking history, and using bronchodilators were eligible. Exclusion criteria were a primary diagnosis of asthma or cardiac disease, or presence of disease that would affect mortality or participation (eg, confusion). Randomisation of 233 patients allocated 111 to the intervention group and 122 to the control group.
Both groups received usual care and brief nurse-led education about management of their disease. In addition, the intervention group received an individualised written AP, encouragement to contact the nurse for more information if needed, and two standardised telephone reinforcement sessions at 1 and 4 months following randomisation. The nurse, in consultation with physician, was able to provide a course of corticosteroids and antibiotics.
Patients recorded their symptoms daily and completed the 24-hour Clinical COPD Questionnaire (CCQ) every 3 days, for 6 months. The primary outcome was time to recovery of health status following an exacerbation, defined as a return to pre-exacerbation CCQ scores. Secondary outcomes included the time delay between exacerbation onset and exacerbation-related healthcare contact and exacerbationrelated self-efficacy.
CCQ data were available for 216 patients. The mean symptom recovery time was shorter in the AP group by 3.68 days (95% CI 0.04 to 7.32). Patients in the AP group with an exacerbation sought treatment 2.9 days earlier (95% CI 2.4 to 3.5) than patients in the control group. The change in self-efficacy was higher in favour of the AP group. There were no differences in the number of exacerbations or healthcare contact between the groups.
An AP with case manager support enhanced early detection of exacerbations and expedited recovery from symptoms following these events.
在 COPD 患者中，由个案经理提供支持的行动计划是否会导致更早地与医疗保健专业人员接触，并从恶化中更快地恢复？
随机对照试验，分配隐藏。患者不知道研究目的。
欧洲的 8 家地区医院和 5 家普通科诊所。
符合条件的患者为年龄> 40 岁、有大量吸烟史且使用支气管扩张剂的 COPD 成人。排除标准为初诊哮喘或心脏病，或存在影响死亡率或参与的疾病（如，意识混乱）。对 233 名患者进行随机分组，111 名患者分入干预组，122 名患者分入对照组。
两组均接受常规护理和简短的护士主导的疾病管理教育。此外，干预组还获得了个性化的书面行动计划，鼓励在需要时与护士联系以获取更多信息，并在随机分组后 1 个月和 4 个月进行两次标准化电话强化治疗。护士可与医生协商，为患者提供皮质类固醇和抗生素治疗。
患者每天记录症状，并在 6 个月内每 3 天完成 24 小时临床 COPD 问卷（CCQ）。主要结果是恶化后健康状况恢复的时间，定义为恢复到恶化前的 CCQ 评分。次要结果包括恶化开始与恶化相关的医疗接触之间的时间延迟以及恶化相关的自我效能。
216 名患者提供了 CCQ 数据。行动计划组的平均症状恢复时间缩短了 3.68 天（95%CI 0.04 至 7.32）。与对照组相比，行动计划组的患者在恶化后 2.9 天内寻求治疗（95%CI 2.4 至 3.5）。自我效能的变化更有利于行动计划组。两组间的恶化次数或医疗接触次数没有差异。
个案经理支持的行动计划增强了对恶化的早期检测，并加快了这些事件后症状的恢复。
