The Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
BMC Health Serv Res. 2013 Oct 3;13:385. doi: 10.1186/1472-6963-13-385.
The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD.
The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was adherence to the disease-management-programme measured at patient-level by use of specific services from general practice. Secondary outcomes were use of out-of-hours-services, outpatient-clinic, and emergency-department and hospital-admissions.
The intervention practices provided more planned preventive consultations, additional preventive consultations and spirometries than non-intervention practices. A comparison of the development in the intervention practices with the development in the control-practices showed that the intervention resulted in more planned preventive-consultations, fewer conventional consultations and fewer patients admitted without a lung-related-diagnosis.
Use of the active implementation model for the disease-management-programme for COPD changed the healthcare utilization in accordance with the programme.
Clinicaltrials.gov identifier: NCT01228708.
慢性病患者人数不断增加，这对医疗保健规划和有效护理提出了更高的要求。实施疾病管理计划是满足这一需求的一种选择。然而，关于实施过程及其对患者的影响的知识还很有限，只有少数研究报告了针对慢性阻塞性肺疾病（COPD）患者的疾病管理计划的有效性。本文的目的是确定针对主要多病症之一 COPD 患者的疾病管理计划的积极实施模型对医疗保健利用的影响。
在 2008 年 11 月至 2010 年 11 月期间，丹麦中部地区正在进行一项新的 COPD 疾病管理计划的标准实施。我们希望测试一种使用突破系列、学术详细信息和 COPD 患者名单的策略。该策略针对全科医生和三家服务于约 60,000 名 35 岁及以上居民的医院，包括针对专业人员、组织和患者的干预措施。该研究是一项非盲块和集群随机对照试验，以全科医生实践为随机分组单位。在丹麦 Ringkoebing-Skjern 市，16 家全科医生实践参与其中，共有 38 名全科医生被随机分配到干预组或对照组。一个类似的邻近市充当外部对照组，其中包括 9 家全科医生实践和 25 名全科医生。基于与医疗保健系统肺部相关接触的健康登记数据的算法确定了 2736 名在研究结束时仍存活的患者。该研究的人群包括 1372 名（69.2%）对基线问卷做出回应并确认其 COPD 诊断的患者；458 名（33.4%）患者来自干预组，376 名（27.4%）来自对照组，538 名（39.2%）来自外部对照组。主要结局是通过使用全科医生的特定服务来衡量患者层面的疾病管理计划的依从性。次要结局是使用非工作时间服务、门诊诊所、急诊部和住院治疗。
与非干预实践相比，干预实践提供了更多计划的预防咨询、额外的预防咨询和肺功能检查。对干预实践的发展与对照组的发展进行比较后发现，干预导致了更多的计划预防咨询、更少的常规咨询以及更多没有肺部相关诊断的患者入院。
针对 COPD 的疾病管理计划的积极实施模型的使用改变了医疗保健的利用情况，符合该计划的要求。
Clinicaltrials.gov 标识符：NCT01228708。
