Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention.
BACKGROUND
Self-management interventions improve various outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease.


METHODS
A multicenter, randomized clinical trial was carried out in 7 hospitals from February 1998 to July 1999. All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year. Patients were assigned to a self-management program or to usual care. The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up. Over 12 months, data were collected regarding the primary outcome and number of hospitalizations; secondary outcomes included emergency visits and patient health status.


RESULTS
Hospital admissions for exacerbation of COPD were reduced by 39.8% in the intervention group compared with the usual care group (P =.01), and admissions for other health problems were reduced by 57.1% (P =.01). Emergency department visits were reduced by 41.0% (P =.02) and unscheduled physician visits by 58.9% (P =.003). Greater improvements in the impact subscale and total quality-of-life scores were observed in the intervention group at 4 months, although some of the benefits were maintained only for the impact score at 12 months.


CONCLUSIONS
A continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status. This approach of care can be implemented within normal practice.
Bourbeau
Jean
J
Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, and Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada. jean.bourbeau@mcgill.ca
Julien
Marcel
M
Maltais
François
F
Rouleau
Michel
M
Beaupré
Alain
A
Bégin
Raymond
R
Renzi
Paolo
P
Nault
Diane
D
Borycki
Elizabeth
E
Schwartzman
Kevin
K
Singh
Ravinder
R
Collet
Jean-Paul
JP
D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care