Marlies Zwerink1, Huib Am Kerstjens2, Job van der Palen1,3, Paul van der Valk1, Marjolein Brusse-Keizer1, Gerhard Zielhuis4, Tanja Effing5,6. 1. Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands. 2. Department of Pulmonology, University of Groningen, and University Medical Center Groningen, Groningen, The Netherlands. 3. Department of Research Methodology, Measurement and Data Analysis, University Twente, Enschede, The Netherlands. 4. Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Southern Adelaide Local Health Network, Respiratory Research Unit, Repatriation General Hospital, Daw Park, South Australia, Australia. 6. School of Medicine, Flinders University, Adelaide, South Australia, Australia.
Abstract
BACKGROUND AND OBJECTIVE: Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. METHODS:Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. RESULTS: Data of 70 COPD patients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32-115) compared with the CG (82, IQR: 22-186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2-68.6 vs CG: 55.9, IQR: 31.2-96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28-1.79) and 2.27 (95% CI: 1.11-4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. CONCLUSION: Self-treatment of exacerbations is beneficial in COPD patients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.
RCT Entities:
BACKGROUND AND OBJECTIVE: Long-term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost-)effectiveness of a self-management programme with or without self-treatment of exacerbations after 2 years follow-up. METHODS: Self-management with or without self-treatment of exacerbations was randomly assigned to patients. All patients participated in four self-management meetings. Patients in the self-treatment group (STG) also learned to use an action plan to start a course of prednisolone and/or antibiotics in case of worsening of symptoms. Primary outcome was the duration and severity of exacerbations. RESULTS: Data of 70 COPDpatients in the STG and 72 patients in the control group (CG) were analysed. Over 2 years, the median number of exacerbation days was significantly lower in the STG (50, IQR: 32-115) compared with the CG (82, IQR: 22-186) (P = 0.047), as was the mean symptom score of an exacerbation (STG: 43.4, IQR 27.2-68.6 vs CG: 55.9, IQR: 31.2-96.8) (P = 0.029). Also, patients in the STG visited the respiratory physician and emergency department less frequently than patients in the CG with incidence rate ratios of 1.52 (95% CI: 1.28-1.79) and 2.27 (95% CI: 1.11-4.62), respectively. Direct medical costs per patient over 2 years were €1078 lower in the STG. CONCLUSION: Self-treatment of exacerbations is beneficial in COPDpatients without significant comorbidities because it reduces exacerbation duration, exacerbation severity and health-care utilization leading to considerable cost savings.
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: Lonneke Boer; Erik Bischoff; Maarten van der Heijden; Peter Lucas; Reinier Akkermans; Jan Vercoulen; Yvonne Heijdra; Willem Assendelft; Tjard Schermer Journal: JMIR Mhealth Uhealth Date: 2019-10-09 Impact factor: 4.773
Authors: Joanne Sloots; Mirthe Bakker; Job van der Palen; Michiel Eijsvogel; Paul van der Valk; Gerard Linssen; Clara van Ommeren; Martijn Grinovero; Monique Tabak; Tanja Effing; Anke Lenferink Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-07-15
Authors: Lonneke M Boer; Maarten van der Heijden; Nathalie Me van Kuijk; Peter Jf Lucas; Jan H Vercoulen; Willem Jj Assendelft; Erik W Bischoff; Tjard R Schermer Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-10-10
Authors: Keir Philip; Andrew Cumella; Joe Farrington-Douglas; Michael Laffan; Nicholas Hopkinson Journal: BMJ Open Date: 2020-09-09 Impact factor: 2.692