Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Eur Respir J. 2018 May 10;51(5). doi: 10.1183/13993003.01873-2017. Print 2018 May.
Disease management of chronic obstructive pulmonary disease (COPD) is complex and shortcomings in general practice care for COPD are common. A care bundle is a disease management aid used as a reminder and for steering specific elements of care. Our objectives were to test whether a COPD care bundle delivered to general practitioners (GPs) and practice assistants increases the implementation of key elements of COPD care.The study was a cluster-randomised clinical trial, with 1:1 randomisation of GPs and a 1-year follow-up. The intervention introduced a COPD care bundle and aimed at enhancing collaboration between GPs and practice assistants. The control group continued usual care. The primary outcome measure was the composite score from nine key elements of COPD care measured at the patient level.We enrolled 35 GPs and 216 patients with a median age of 69 years, 59% female, 69% Global Initiative for Chronic Obstructive Lung Disease group A or B. After 1 year, the between-group difference in change of the primary outcome measure was +2.2 (95% CI +1.5- +2.9) in favour of the intervention group. The intervention was associated with significantly higher implementation rates in seven out of nine key elements of care.Disease management using a COPD care bundle increased the implementation of key elements of COPD care in general practice.
慢性阻塞性肺疾病（COPD）的疾病管理较为复杂，且全科医生在 COPD 常规护理方面存在诸多不足。护理包是一种疾病管理辅助工具，可用于提醒和指导特定的护理内容。我们的目的是检验将 COPD 护理包提供给全科医生（GP）和助理能否增加 COPD 护理的关键内容的实施。该研究是一项集群随机临床试验，GP 采用 1:1 随机分组，随访 1 年。干预措施引入了 COPD 护理包，旨在加强 GP 和助理之间的合作。对照组继续常规护理。主要结局指标为患者层面 9 项 COPD 护理关键内容的综合评分。我们共纳入 35 名 GP 和 216 名中位年龄 69 岁的 COPD 患者，其中女性占 59%，GOLD 组 A 或 B 占 69%。1 年后，干预组的主要结局指标变化的组间差异为+2.2（95%CI +1.5-+2.9），有利于干预组。干预组在 9 项护理关键内容中的 7 项内容的实施率显著更高。使用 COPD 护理包进行疾病管理可增加全科医学中 COPD 护理的关键内容的实施。
