OBJECTIVE: To investigate the long-term effectiveness of a general practice monitoring system with respiratory expert recommendations for general practitioners' management of patients with chronic obstructive pulmonary disease (COPD), compared with usual care. DESIGN, SETTINGS AND PARTICIPANTS: A multicentre randomised controlled trial of patients with COPD, clustered by general practices; 200 participants were recruited to maintain at least 75 participants per group for analysis. The trial took place from July 2005 to February 2008 in the south-western region of the Netherlands. INTERVENTION: Ongoing half-yearly monitoring of COPD patients with respiratory expert recommendations for the GP was compared with usual care. MAIN OUTCOME MEASURES: Primary outcome - Chronic Respiratory Questionnaire (CRQ) score; secondary outcomes - CRQ domain scores, generic health-related quality of life (Short-Form 12 and EuroQol-5D), breathlessness (Modified Medical Research Council score), exacerbations, and decline in forced expiratory volume in 1 second. A detailed process evaluation was performed along with the trial. RESULTS: Data from 170 participants were analysed. Based on repeated measurement analyses, the additional gain in CRQ score during follow-up was 0.004 points for monitoring compared with usual care (95% CI, - 0.172 to 0.180). Also, no important differences between monitoring and the usual care group were found for secondary outcomes. Half the monitoring visits resulted in disease management recommendations by a respiratory expert, and 46% of these recommendations were implemented by the GPs. Patient adherence to lifestyle recommendations was low. CONCLUSION: An expert-supported monitoring system for patients with COPD was not clinically effective. As patients had a pre-existing entry in the monitoring system, the population may be well regulated, with reduced room for improvement. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00542061.
RCT Entities:
OBJECTIVE: To investigate the long-term effectiveness of a general practice monitoring system with respiratory expert recommendations for general practitioners' management of patients with chronic obstructive pulmonary disease (COPD), compared with usual care. DESIGN, SETTINGS AND PARTICIPANTS: A multicentre randomised controlled trial of patients with COPD, clustered by general practices; 200 participants were recruited to maintain at least 75 participants per group for analysis. The trial took place from July 2005 to February 2008 in the south-western region of the Netherlands. INTERVENTION: Ongoing half-yearly monitoring of COPDpatients with respiratory expert recommendations for the GP was compared with usual care. MAIN OUTCOME MEASURES: Primary outcome - Chronic Respiratory Questionnaire (CRQ) score; secondary outcomes - CRQ domain scores, generic health-related quality of life (Short-Form 12 and EuroQol-5D), breathlessness (Modified Medical Research Council score), exacerbations, and decline in forced expiratory volume in 1 second. A detailed process evaluation was performed along with the trial. RESULTS: Data from 170 participants were analysed. Based on repeated measurement analyses, the additional gain in CRQ score during follow-up was 0.004 points for monitoring compared with usual care (95% CI, - 0.172 to 0.180). Also, no important differences between monitoring and the usual care group were found for secondary outcomes. Half the monitoring visits resulted in disease management recommendations by a respiratory expert, and 46% of these recommendations were implemented by the GPs. Patient adherence to lifestyle recommendations was low. CONCLUSION: An expert-supported monitoring system for patients with COPD was not clinically effective. As patients had a pre-existing entry in the monitoring system, the population may be well regulated, with reduced room for improvement. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00542061.
Authors: Anke Lenferink; Marjolein Brusse-Keizer; Paul Dlpm van der Valk; Peter A Frith; Marlies Zwerink; Evelyn M Monninkhof; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2017-08-04
Authors: Lucas E M Annelies; Derckx W C C Emmy; Meulepas A Marianne; Smeele J M Ivo; Smeenk W J M Frank; van Schayck P Onno Journal: BMC Res Notes Date: 2012-07-23
Authors: Esther I Metting; Roland A Riemersma; Janwillem H Kocks; Margriet G Piersma-Wichers; Robbert Sanderman; Thys van der Molen Journal: NPJ Prim Care Respir Med Date: 2015-01-08 Impact factor: 2.871