Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands.
BMC Pulm Med. 2020 Jun 18;20(1):176. doi: 10.1186/s12890-020-01213-8.
The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.
Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.
Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).
More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.
Netherlands Trial Register, NTR2268. Registered 31 March 2010.
在初级保健中对慢性阻塞性肺疾病（COPD）综合管理（COST-）有效性的集群随机对照试验（RECODE）表明，与常规护理（基于指南的非计划性护理）相比，初级保健中的综合疾病管理（IDM）对 COPD 患者的生活质量（QOL）没有影响。只有初级保健中的一部分 COPD 患者可能从 IDM 中受益。因此，我们研究了哪些患者从 IDM 中受益，以及患者特征是否可以预测随着时间的推移临床改善。
RECODE 试验中 1086 例 COPD 患者的事后分析。使用基线特征作为预测因子进行逻辑回归分析，以检查 QOL 改善的决定因素，定义为在 IDM 12 和 24 个月后，临床 COPD 问卷（CCQ）的最小下降 0.4 点。我们还进行了调节分析，以检查 IDM 和常规护理之间临床改善的预测因子是否存在差异。
无论治疗类型如何，更严重的呼吸困难（MRC）是 12 个月和 24 个月时 QOL 临床改善的最重要预测因子，表明这些患者有最大的改善空间。IDM 的临床改善与女性性别（12 个月）和年轻（24 个月）有关，而常规护理的改善与抑郁有关（24 个月）。
随着时间的推移，更严重的呼吸困难是 COPD 患者 QOL 改善的关键预测因子。需要进一步研究与 IDM 相关的临床改善相关的患者特征，以便向受益最大的患者提供 IDM 计划，并可能根据其他患者群体的需求进行调整。
荷兰试验登记处，NTR2268。2010 年 3 月 31 日注册。
