- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT00128765
Costs and Effects of Three Modes for Disease Management of Chronic Obstructive Pulmonary Disease in General Practice
Costs and Effects of Three Modes for Disease Management of Chronic Obstructive Pulmonary Disease (COPD) in General Practice. A Randomized Controlled Trial Comparing Regular Practice Nurse Review, Self-management Education and Usual Care
In this randomized controlled trial, three contemporary modes for chronic obstructive pulmonary disease (COPD) management in Dutch general practices are compared for costs and effects:
- usual general practitioner (GP) care (at patient's initiative);
- regular practice nurse review; and
- integrated self-management education.
All three interventions are based on existing guidelines, materials, and field experiences.
Aperçu de l'étude
Statut
Les conditions
Description détaillée
Considering the ageing of the Dutch population and the current and increasing shortage of general practitioners (GPs), the capacity of primary healthcare is a major and growing concern. Delegation of care normally provided by GPs with care provided by trained practice nurses is now rapidly emerging for patients with chronic respiratory disease, i.e. asthma and chronic obstructive pulmonary disease (COPD). However, most general practices still provide care at initiative of the patient self, because of the lack in scientific evidence and the costs of implementing a regular care structure. Self-care by patients may be an alternative to alleviate the growing load on primary health care.
The following two main research questions are addressed in this study.
- Does an integrated self-management education intervention for patients with COPD in general practice contribute to attaining long-term treatment targets, compared to regular monitoring by a practice nurse and usual GP care?
- What is the cost-effectiveness of an integrated self-management education intervention for patients with COPD, compared to regular monitoring by a practice nurse and usual GP care?
Type d'étude
Inscription (Réel)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
-
-
-
Nijmegen, Pays-Bas, 6500 HB
- Radboud University, Department of General Medicine
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-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Registered in one of the general practices participating in the study
- Diagnosis of COPD, with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) stage I, II or III
- Age ≥35 years
- Willing to provide written informed consent
Exclusion Criteria:
- Very poor prognosis with regard to respiratory condition (GOLD stage IV)
- Severe co-morbid conditions with a reduced life expectancy
- Unable to communicate in the Dutch language
- Objections to one or more of the disease management modes in the study
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
---|---|
Comparateur actif: usual care
usual care, i.e.
COPD care at patient's own initiative, mostly for medical help during exacerbations
|
care at initiative of the patient (usual GP care)
|
Expérimental: monitoring controls
regular COPD care (monitoring) provided by practice nurse according to current COPD guidelines
|
protocol based on existing Guidelines: Dutch College of General Practitioners (NHG) Global Initiative for Chronic Obstructive Lung Disease (GOLD)
|
Expérimental: self-management
disease specific self-management program 'Living Well with COPD'
|
disease specific self-management program 'Living Well with COPD', developed in Montreal, Canada
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Délai |
---|---|
disease-specific health-related quality of life (HRQoL)
Délai: two years
|
two years
|
Mesures de résultats secondaires
Mesure des résultats |
Délai |
---|---|
the number of exacerbations
Délai: two years
|
two years
|
generic quality of life
Délai: two years
|
two years
|
decline post- and pre-bronchodilator (BD) lung function indices
Délai: two years
|
two years
|
level of respiratory symptoms
Délai: two years
|
two years
|
satisfaction with the health care received
Délai: two years
|
two years
|
compliance with (non-) pharmaceutical treatment
Délai: two years
|
two years
|
direct and indirect medical costs
Délai: two years
|
two years
|
COPD related self-efficacy
Délai: two years
|
two years
|
COPD coping styles
Délai: two years
|
two years
|
Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chaise d'étude: Chris van Weel, FRCP, Department of General Practice, Radboud University, Nijmegen, The Netherlands
- Directeur d'études: Tjard Schermer, PhD, Department of General Practice, Radboud University, Nijmegen, The Netherlands
- Chercheur principal: Erik Bischoff, MD, Department of General Practice, Radboud University, Nijmegen, The Netherlands
Publications et liens utiles
Publications générales
- Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupre A, Begin R, Renzi P, Nault D, Borycki E, Schwartzman K, Singh R, Collet JP; Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Sante du Quebec. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003 Mar 10;163(5):585-91. doi: 10.1001/archinte.163.5.585.
- Monninkhof E, van der Valk P, van der Palen J, van Herwaarden C, Partridge MR, Zielhuis G. Self-management education for patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 2003 May;58(5):394-8. doi: 10.1136/thorax.58.5.394.
- Bourbeau J, Nault D, Dang-Tan T. Self-management and behaviour modification in COPD. Patient Educ Couns. 2004 Mar;52(3):271-7. doi: 10.1016/S0738-3991(03)00102-2.
- Bischoff EW, Akkermans R, Bourbeau J, van Weel C, Vercoulen JH, Schermer TR. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial. BMJ. 2012 Nov 28;345:e7642. doi: 10.1136/bmj.e7642.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- MONC95582
- ZonMw grant: 945.04.230 (Autre subvention/numéro de financement: ZonMw)
- Picasso grant: 005.2004 (Autre subvention/numéro de financement: Picasso)
- CMO: 2004/249 (Autre identifiant: Medical Ethics Committee)
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