Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): information and health education feedback for improving clinical monitoring and quality-of-life

Carles Valero, Mònica Monteagudo, Maria Llagostera, Xavier Bayona, Sílvia Granollers, Mateo Acedo, Juan J Ferro, Lluïsa Rodríguez-Latre, Jesús Almeda, Laura Muñoz, COPD Group of SAP Baix LLobregat Centre, Eva Pérez, M Dolores Villena, Núria Peñalver, Ana Garrote, Ana Carrera, Dolores Rodríguez, Sonia González, Carolina Morata, Josep Toll, Maribel Rodríguez, Helena Hernández, Sofia Centeno, Virtudes López, Beatriu Fuentes, Montserrat Burull, Ana Gómez, Marta D'Lacoste, Eva Cabello, Olga Ortiz, Carmen López, Judith Parcet, Ma Elena Galán, Carles Rius, Encarna Sánchez, Eulalia Ruiz, Jordi Segarra, Isabel Montané, Marta Soler, Brugués Grau, Pere Barreto, Núria Pérez, Laura González, Ma Jesús Santamaría, Pau Wennberg, Manoli Vega, Júlia Ventura, Francisco Alguacil, Pilar Monge, Isabel Porta, Ma Rosario Mateo, Ma Jesús Cerain, Ma Teresa Julià, Inés Monte, Anna Bergua, Angeles Lázaro, Francisco J López Malo, Cristina Alcaraz, Tomás Pallarés, José Fraj, Ma Paz Rodríguez, Pilar Postigo, Maribel Collado, Julio Muñoz, Eva García Pérez, Emilia Bosch, Begoña Gómez, Jesús V Muniesa, Román Rabaneda, Francisco Ridao, Lina Jurado, Francesc Serra, Dora Ruenz, Marina Payá, Emilia Perdigón, Purificación Robles, Miguel García, Anna Calvet, Maite Duran, Inmaculada García, Ma Teresa Vintro, María Soler, Carmen Galera, Emília Carmés, Dolores Ruiz, Sofia Lara, Angel Espín, Lucila Gozalbo, Rita Fernández, Sílvia Pons, Maite Peñarrubia, Pilar Núñez, Josep Verdú, Carmen Carretero, Javier Peligro, Miguel Moreno, Alejandro Oriol, Ma Teresa Pallerols, Pere Sellas, Ferran Villavecchia, Montserrat Just, Emilia Aparicio, Elisenda Florensa, Ma Pilar Fusté, Carmen Delgado, Carmen Morillo, Antonio Vives, Elvira Zarza, Raquel Adroer, Celsa Fernández, Marta Sarró, Ma Pilar Fernández, Luís Solsona, Joana Pérez, Jose L Ballbé, Neus Profitós, Núria Sanfeliu, Montse Català, Carles Rubio, María Ramos, Maria Berengué, Maria M Pedrosa, Sílvia Cañadas, Mercedes Secorun, Xavier Monteverde, Marta Constanza, Teresa Badía, Isabel Vergés, Pilar Oriol, Miguel Fuentes, Ma Isabel Fuentes, Yolanda Rico, Belén Henares, Antonio Ortuño, Flora López, Juan Fortea, Lluís Esteve, Asunción Oliete, David Gosálbez, Eugeni Guerra, Carme Tamayo, Socorro González, Ana R Hernández, Inés Vázquez, Carmen Barrio, Rosa García, Alicia Val, Roser Ginés, Ma Eugenia Corral, Francisca de la Torre, Luisa Calvet, Esperanza Mendoza, Josep Ma Vidal, Inmaculada Bernal, Elena Martínez, Marta Montagut, Juan C Caballero, José Ramón, Josep Ma Benet, Pilar Cervera, Ana Dosío, Encarna Navarro, Carmen Claramunt, Teresa Sáez, José Luís Vallina, Anna Alemany, Xavier Castro, Ma José Torrecilla, Pere Simonet, Antoni Padilla, Rosa Villafafila, Carmen Lacemberri, Carmen García, Sonia Moreiras, José Luís Bravo, Ma Victoria Vico, Lluís Esteve, Asunsión Oliete, Ma Dolores González, Rafael Martínez, Carles Valero, Mònica Monteagudo, Maria Llagostera, Xavier Bayona, Sílvia Granollers, Mateo Acedo, Juan J Ferro, Lluïsa Rodríguez-Latre, Jesús Almeda, Laura Muñoz, COPD Group of SAP Baix LLobregat Centre, Eva Pérez, M Dolores Villena, Núria Peñalver, Ana Garrote, Ana Carrera, Dolores Rodríguez, Sonia González, Carolina Morata, Josep Toll, Maribel Rodríguez, Helena Hernández, Sofia Centeno, Virtudes López, Beatriu Fuentes, Montserrat Burull, Ana Gómez, Marta D'Lacoste, Eva Cabello, Olga Ortiz, Carmen López, Judith Parcet, Ma Elena Galán, Carles Rius, Encarna Sánchez, Eulalia Ruiz, Jordi Segarra, Isabel Montané, Marta Soler, Brugués Grau, Pere Barreto, Núria Pérez, Laura González, Ma Jesús Santamaría, Pau Wennberg, Manoli Vega, Júlia Ventura, Francisco Alguacil, Pilar Monge, Isabel Porta, Ma Rosario Mateo, Ma Jesús Cerain, Ma Teresa Julià, Inés Monte, Anna Bergua, Angeles Lázaro, Francisco J López Malo, Cristina Alcaraz, Tomás Pallarés, José Fraj, Ma Paz Rodríguez, Pilar Postigo, Maribel Collado, Julio Muñoz, Eva García Pérez, Emilia Bosch, Begoña Gómez, Jesús V Muniesa, Román Rabaneda, Francisco Ridao, Lina Jurado, Francesc Serra, Dora Ruenz, Marina Payá, Emilia Perdigón, Purificación Robles, Miguel García, Anna Calvet, Maite Duran, Inmaculada García, Ma Teresa Vintro, María Soler, Carmen Galera, Emília Carmés, Dolores Ruiz, Sofia Lara, Angel Espín, Lucila Gozalbo, Rita Fernández, Sílvia Pons, Maite Peñarrubia, Pilar Núñez, Josep Verdú, Carmen Carretero, Javier Peligro, Miguel Moreno, Alejandro Oriol, Ma Teresa Pallerols, Pere Sellas, Ferran Villavecchia, Montserrat Just, Emilia Aparicio, Elisenda Florensa, Ma Pilar Fusté, Carmen Delgado, Carmen Morillo, Antonio Vives, Elvira Zarza, Raquel Adroer, Celsa Fernández, Marta Sarró, Ma Pilar Fernández, Luís Solsona, Joana Pérez, Jose L Ballbé, Neus Profitós, Núria Sanfeliu, Montse Català, Carles Rubio, María Ramos, Maria Berengué, Maria M Pedrosa, Sílvia Cañadas, Mercedes Secorun, Xavier Monteverde, Marta Constanza, Teresa Badía, Isabel Vergés, Pilar Oriol, Miguel Fuentes, Ma Isabel Fuentes, Yolanda Rico, Belén Henares, Antonio Ortuño, Flora López, Juan Fortea, Lluís Esteve, Asunción Oliete, David Gosálbez, Eugeni Guerra, Carme Tamayo, Socorro González, Ana R Hernández, Inés Vázquez, Carmen Barrio, Rosa García, Alicia Val, Roser Ginés, Ma Eugenia Corral, Francisca de la Torre, Luisa Calvet, Esperanza Mendoza, Josep Ma Vidal, Inmaculada Bernal, Elena Martínez, Marta Montagut, Juan C Caballero, José Ramón, Josep Ma Benet, Pilar Cervera, Ana Dosío, Encarna Navarro, Carmen Claramunt, Teresa Sáez, José Luís Vallina, Anna Alemany, Xavier Castro, Ma José Torrecilla, Pere Simonet, Antoni Padilla, Rosa Villafafila, Carmen Lacemberri, Carmen García, Sonia Moreiras, José Luís Bravo, Ma Victoria Vico, Lluís Esteve, Asunsión Oliete, Ma Dolores González, Rafael Martínez

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a health problem that is becoming increasingly attended-to in Primary Care (PC). However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG). The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL) of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education.

Method/design: Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC) within the administrative area of the Costa de Ponent (near Barcelona). All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse) derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy). The sample random includes a total of 801 patients (> or = 40 years of age), recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical Research Council (MRC) and the QoL, evaluated with the St George's Respiratory Questionnaire (SGRQ). The variables are obtained at the start and the end of the intervention. Information from follow-up visits focuses on the changes in life-style activities of the patient.

Discussion: This study is conducted with the objective of generating evidence that shows that implementation of awareness programs directed towards health-care professionals as well as patients in the context of PC can produce an increase in the QoL and a decrease in the disease exacerbation, compared to standard clinical practice.

Trial registration: Clinical Trials.gov Identifier: NCT00922545;

Figures

Figure 1
Figure 1
Algorithm of the study.

References

    1. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932–946. doi: 10.1183/09031936.04.00014304.
    1. Sobradillo V, Miravitlles M, Jimenez CA, Gabriel R, Viejo JL, Masa JF, Viejo JL, Fernández-Fau L. Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): prevalence of chronic respiratory symptoms and airflow limitation. Arch Bronconeumol. 1999;35(4):159–166.
    1. Brotons B, Perez JA, Sanchez-Toril F, Soriano S, Hernandez J, Belenguer JL. The prevalence of chronic obstructive pulmonary disease and asthma. A cross-sectional study. Arch Bronconeumol. 1994;30(3):149–152.
    1. Marco JL, Martin Berra JC, Corres IM, Luque DR, Zubillaga GG. Chronic obstructive lung disease in the general population. An epidemiologic study performed in Guipuzcoa. Arch Bronconeumol. 1998;34(1):23–27.
    1. Jaen A, Ferrer A, Ormaza I, Rue M, Domingo C, Marin A. Prevalence of chronic bronchitis, asthma and airflow limitation in an urban-industrial area of Catalonia. Arch Bronconeumol. 1999;35(3):122–128.
    1. Alvarez-Sala J, Cimas E, Masa JF, Miravitlles M, Molina J, Naberan K, Simonet P, Viejo JL. Recommendations for the care of the patient with chronic obstructive pulmonary disease. Arch Bronconeumol. 2001;37(7):269–278.
    1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256–1276.
    1. Miravitlles M, Murio C, Guerrero T, Gisbert R. Costs of chronic bronchitis and COPD: a 1-year follow-up study. Chest. 2003;123(3):784–791. doi: 10.1378/chest.123.3.784.
    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, Van-Wel C, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–555. doi: 10.1164/rccm.200703-456SO.
    1. Ministerio de Sanidad y Consumo [ ]. Madrid: Ministerio de Sanidad y Consumo; 2008 [citado 9 de enero 2009]. Disponible a.
    1. Gingter C, Wilm S, Abholz HH. Is COPD a rare disease? Prevalence and identification rates in smokers aged 40 years and over within general practice in Germany. Fam Pract. 2008;26(1):3–9. doi: 10.1093/fampra/cmn084.
    1. Roche N, Huchon G. Epidemiology of chronic obstructive pulmonary disease. Rev Prat. 2004;54(13):1408–1413.
    1. Agencia de Evaluación de Tecnologías Sanitarias (AETS) Instituto de Salud Carlos III- Ministerio de Sanidad y Consumo. "Evaluaciín de la eficacia, efectividad y coste-efectividad de los distintos abordajes terapéuticos para dejar de fumar". Madrid: AETS-Instituto de Salud Carlos III, Septiembre de; 2003.
    1. Rutschmann OT, Janssens JP, Vermeulen B, Sarasin FP. Knowledge of guidelines for the management of COPD: a survey of primary care physicians. Respir Med. 2004;98(10):932–937. doi: 10.1016/j.rmed.2004.03.018.
    1. Decramer M, Bartsch P, Pauwels R, Yernault JC. Management of COPD according to guidelines. A national survey among Belgian physicians. Monaldi Arch Chest Dis. 2003;59(1):62–80.
    1. Miravitlles M, Mayordomo C, Artes M, Sanchez-Agudo L, Nicolau F, Segu JL. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Estudio Observacional de la Limitacion Obstructiva al Flujo aEreo. Respir Med. 1999;93(3):173–179. doi: 10.1016/S0954-6111(99)90004-5.
    1. Jimenez-Ruiz CA, Masa F, Miravitlles M, Gabriel R, Viejo JL, Villasante C, Sobradillo V. Smoking characteristics: differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest. 2001;119(5):1365–1370. doi: 10.1378/chest.119.5.1365.
    1. Coultas DB, Mapel D, Gagnon R, Lydick E. The health impact of undiagnosed airflow obstruction in a national sample of United States adults. Am J Respir Crit Care Med. 2001;164(3):372–377.
    1. Renwick DS, Connolly MJ. Prevalence and treatment of chronic airways obstruction in adults over the age of 45. Thorax. 1996;51(2):164–168. doi: 10.1136/thx.51.2.164.
    1. Huchon GJ, Vergnenegre A, Neukirch F, Brami G, Roche N, Preux PM. Chronic bronchitis among French adults: high prevalence and underdiagnosis. Eur Respir J. 2002;20(4):806–812. doi: 10.1183/09031936.02.00042002.
    1. Shin C, Lee S, Abbott RD, Kim JH, Lee SY, In KH, Kimm K. Respiratory symptoms and undiagnosed airflow obstruction in middle-aged adults: the Korean Health and Genome Study. Chest. 2004;126(4):1234–1240. doi: 10.1378/chest.126.4.1234.
    1. Peña VS, Miravitlles M, Gabriel R, Jimenez-Ruiz CA, Villasante C, Masa JF, Viejo JL, Fernández-Fau L. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study. Chest. 2000;118(4):981–989. doi: 10.1378/chest.118.4.981.
    1. Miravitlles M, Fernandez I, Guerrero T, Murio C. Development and results of a screening program for COPD in primary care. The PADOC Project (Program for the Increase in the Diagnosis of COPD in Primary Care. Arch Bronconeumol. 2000;36(9):500–505.
    1. Miravitlles M, de la Roza C, Morera J, Montemayor T, Gobartt E, Martin A, Alvarez-Sala JL. Chronic respiratory symptoms, spirometry and knowledge of COPD among general population. Respir Med. 2006;100(11):1973–1980. doi: 10.1016/j.rmed.2006.02.024.
    1. Naberan K. Survey about Barcelona Health Center General Practitioners' therapeutic attitude and control criteria of patients with respiratory chronic diseases. Aten Primaria. 1994;13(3):112–116.
    1. Kaminsky DA, Marcy TW, Bachand M, Irvin CG. Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians. Respir Care. 2005;50(12):1639–1648.
    1. Sanjuas C. Dyspnea and quality of life in chronic obstructive pulmonary disease. Arch Bronconeumol. 2002;38(10):485–488.
    1. Kesten S, Chapman KR. Physician perceptions and management of COPD. Chest. 1993;104(1):254–258. doi: 10.1378/chest.104.1.254.
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–586.
    1. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992;145(6):1321–1327.
    1. Ferrer M, Alonso J, Prieto L, Plaza V, Monso E, Marrades R, Aguar MC, Khalaf A, Antó JM. Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. Eur Respir J. 1996;9(6):1160–1166. doi: 10.1183/09031936.96.09061160.
    1. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42(10):773–778. doi: 10.1136/thx.42.10.773.
    1. Guell R, Casan P, Sangenis M, Morante F, Belda J, Guyatt GH. Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ) Eur Respir J. 1998;11(1):55–60. doi: 10.1183/09031936.98.11010055.
    1. Barbera JA, Peces-Barba G, Agusti AG, Izquierdo JL, Monso E, Montemayor T, Viejo JL. Clinical guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease. Arch Bronconeumol. 2001;37(6):297–316.
    1. Nigg CR, Burbank PM, Padula C, Dufresne R, Rossi JS, Velicer WF, Laforge RG, Prochaska JO. Stages of change across ten health risk behaviors for older adults. Gerontologist. 1999;39(4):473–482.
    1. Prochaska JO, Diclemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47(9):1102–1114. doi: 10.1037/0003-066X.47.9.1102.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.
    1. Weingarten S. Translating practice guidelines into patient care: guidelines at the bedside. Chest. 2000;118(2 Suppl):4S–7S. doi: 10.1378/chest.118.2_suppl.4S.
    1. Phanareth K, Hansen LS, Christensen LK, Laursen LC, Hansen EF. Treatment of acute severe asthma and chronic obstructive pulmonary disease in Danish hospitals. Do national recommendations improve on the quality of the treatment? Respir Med. 2002;96(9):653–658. doi: 10.1053/rmed.2002.1331.
    1. O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. WITHDRAWN: Audit and feedback versus alternative strategies: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007. p. CD000260.
    1. Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002;19(3):398–404. doi: 10.1183/09031936.02.00063702.
    1. Schunemann HJ, Griffith L, Jaeschke R, Goldstein R, Stubbing D, Guyatt GH. Evaluation of the minimal important difference for the feeling thermometer and the St. George's Respiratory Questionnaire in patients with chronic airflow obstruction. J Clin Epidemiol. 2003;56(12):1170–1176. doi: 10.1016/S0895-4356(03)00115-X.
    1. Giner J, Basualdo LV, Casan P, Hernandez C, Macian V, Martinez I, Mengibar A. Guideline for the use of inhaled drugs. The Working Group of SEPAR: the Nursing Area of the Sociedad Espanola de Neumologia y Cirugia Toracica. Arch Bronconeumol. 2000;36(1):34–43.
    1. Naberan K, Calvo E, García L, Hernández MF, Hernández E, Jorge F. Factores de riesgo. Manejo del asma en Atención Primaria. Recomendaciones semFYC. Edide, Barcelona. 1996. pp. 13–18.
    1. Flor X, Rodriguez M, Gallego L, Alvarez I, Juvanteny J, Fraga MM, Sanchez L. Do our asthma patients still use inhalers incorrectly? Aten Primaria. 2003;32(5):269–274. doi: 10.1157/13051590.
    1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for diagnosis, management and prevention of COPD. updated 2007.
    1. Instituto Nacional de Estadística [ ]. Madrid: Instituto Nacional de Estadística; 1979 [citado 9 de enero de 2009]. Disponible en.
    1. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27(Suppl 3):S178–S189. doi: 10.1097/00005650-198903001-00015.
    1. Cohen J. Statistical power analisys for the behavioral sciences. Second. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
    1. Naberan K, de la RC, Lamban M, Gobartt E, Martin A, Miravitlles M. Use of spirometry in the diagnosis and treatment of chronic obstructive pulmonary disease in primary care. Arch Bronconeumol. 2006;42(12):638–644.
    1. De Miguel J, Izquierdo JL, Molina J, Rodriguez JM, de Lucas P, Gaspar G. Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors. Arch Bronconeumol. 2003;39(5):203–208. doi: 10.1157/13047333.
    1. Izquierdo JL, Rodriguez JM, de Lucas P, Martin A, Gobartt E. Has the treatment of COPD changed in Spain? Results of a community multicenter study (VICE) Rev Clin Esp. 2008;208(1):18–25. doi: 10.1157/13115003.
    1. Miravitlles M, de la RC, Naberan K, Lamban M, Gobartt E, Martin A. Use of spirometry and patterns of prescribing in COPD in primary care. Respir Med. 2007;101(8):1753–1760. doi: 10.1016/j.rmed.2007.02.019.
    1. Burgos F. Are quality and the extensive use of spirometry compatible? Arch Bronconeumol. 2006;42(7):311–313.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi