[Is the introduction of clinical management programs for patients with chronic obstructive pulmonary disease useful? Comparison of the effectiveness of two interventions on the clinical progress and care received].

OBJECTIVE

To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2months.

SETTING

Primary Care Centres in two Barcelona Health Areas and their referral hospitals.

PARTICIPANTS

Patients with COPD selected by simple random sampling using any disease code corresponding to COPD.

INTERVENTIONS

I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared.

MAIN MEASUREMENTS

Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations.

RESULTS

Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P=.034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P<.001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P<.003]).

CONCLUSIONS

Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD.