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
Por:
Solanes, I, Bolibar, I, Llauger, MA, Peiro, M, Valverde, P, Fraga, M, Medrano, C, Bigorra, T, Freixas, M, Liguerre, I, Pou, MA, Dominguez, L, Valero, C, Sola, J, Giner, J, Plaza, V
Publicada:
1 mar 2018
Resumen:
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 (11, 12) for the care of patients with COPD after a mean follow-up of 31.2 months.
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: 11: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. 12: 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 (11 and 12, respectively) received the final evaluation. With 11, 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 11 and 12, respectively. The percentage of patients with exacerbations decreased with 11 compared to that of 12 (P < .001), and there were less hospital admissions due to exacerbations with 12 compared to 11 (P < .003]).
Conclusions: Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD. (C) 2017 Elsevier Espana, S.L.U.
Filiaciones:
Solanes, I:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Recerca Biomed IIB St Pau, Serv Neumol, Barcelona, Spain
Bolibar, I:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Ciber Epidemiol & Salud Publ CIBERESP, Serv Epidemiol Clin & Salud Publ,Inst Recerca Bio, Barcelona, Spain
Llauger, MA:
Inst Catald Salut, EAP Encants, Barcelona, Spain
Peiro, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Recerca Biomed IIB St Pau, Serv Neumol, Barcelona, Spain
Valverde, P:
Consorci Sanitari Integral, EAP Gaudi, Barcelona, Spain
Fraga, M:
Inst Catala Salut, EAP Xafarinas, Barcelona, Spain
Medrano, C:
Inst Catala Salut, EAP Clot, Barcelona, Spain
Bigorra, T:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Recerca Biomed IIB St Pau, Serv Neumol, Barcelona, Spain
Freixas, M:
EAP Dreta Eixample, CAP Roger Flor, Barcelona, Spain
Liguerre, I:
Inst Catala Salut, Ambit Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Pou, MA:
Inst Catald Salut, EAP Encants, Barcelona, Spain
Dominguez, L:
Inst Catald Salut, EAP Encants, Barcelona, Spain
Valero, C:
Inst Catala Salut, Ambit Atencio Primaria Barcelona Ciutat, Unitat Avaluacio Sistemes Informacio & Qualitat, Barcelona, Spain
Sola, J:
Hosp Santa Creu & Sant Pau, Dept Epidemiol Clin & Salud Publ, Barcelona, Spain
Giner, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Recerca Biomed IIB St Pau, Serv Neumol, Barcelona, Spain
Plaza, V:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Recerca Biomed IIB St Pau, Serv Neumol, Barcelona, Spain
Gold, Green Published
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