An expert‐supported monitoring system for patients with chronic obstructive pulmonary disease in general practice: results of a cluster randomised controlled trial

• Published in: Medical journal of Australia 2009-09, Vol.191 (5), p.249-254
• Main Authors: Bemt, Lisette, Schermer, Tjard R J, Smeele, Ivo J M, Boonman‐de Winter, Leandra J M, Boxem, Ton, Denis, Joke, Grootens‐Stekelenburg, Joke G, Grol, Richard P T M, Weel, Chris
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cluster Analysis; Disease Progression; Family Practice - methods; Female; Follow-Up Studies; Forced Expiratory Volume - physiology; General aspects; General medicine; Humans; Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Netherlands; Patient Compliance - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Referral and Consultation; Respiratory tract diseases; Retrospective Studies; Surveys and Questionnaires; Time Factors; Vital Capacity - physiology
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/j.1326-5377.2009.tb02777.x

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.