A randomized trial of two types of nurse-assisted home care for patients with COPD.
OBJECTIVE
Whereas pulmonary rehabilitation reduces symptoms and improves the quality of life of patients with COPD and is recommended in management guidelines, few patients have access to rehabilitation services. The purpose of this study was to investigate the effectiveness of increasing access to selected components of pulmonary rehabilitation by providing nurse-assisted home care that was composed of patient education, efforts to improve patient self-management skills, and enhanced follow-up.


METHODS
We conducted a 6-month, randomized, controlled trial.


METHODS
Primary care clinics associated with an urban academic health system.


METHODS
Patients were > or = 45 years of age with a physician diagnosis of COPD, and had a > or = 20-pack-year smoking history, had experienced at least one respiratory symptom during the past 12 months, and had airflow obstruction (ie, FEV1/FVC ratio, < 70%; FEV1, < 80%).


METHODS
Four nurses were trained in the use of the Global Initiative for Chronic Obstructive Lung Disease guidelines, and two of the four nurses received additional training in collaborative management. Patients were randomly assigned to usual care (UC), nurse-assisted medical management (MM), or nurse-assisted collaborative management (CM).


METHODS
The main outcome measures were of generic (Medical Outcome Study 36-item short form [SF-36], illness intrusiveness) and disease-specific (St. George's respiratory questionnaire [SGRQ]) quality of life and self-reported health-care utilization.


RESULTS
Overall, 151 patients (UC group, 51 patients; MM group, 49 patients; and CM group, 51 patients) completed the study, their average age was 69 years, and 56.9% were women. The average change in the SF-36 general health domain for the MM group vs the UC group was 1.1 (95% confidence interval [CI], -7.9 to 11.2), and for the CM group vs the UC group the average change was 2.5 (95% CI, -7.0 to 12.3). The corresponding changes in SGRQ total domain were -2.9 (95% CI, -9.8 to 4.1) and -2.6 (95% CI, -9.5 to 4.3). There was no change in the number of self-reported emergency department visits or hospitalizations, but the utilization of these services was infrequent.


CONCLUSIONS
The findings of our investigation and those from the published literature suggest that interventions to enhance patient education, self-management skills, and follow-up among patients with COPD do not result in clinically meaningful improvements in health status or self-reported health-care utilization. Moreover, future studies of disease management programs for patients with COPD need to evaluate interventions that address associated comorbidities, exercise, and social support.
Coultas
David
D
Department of Internal Medicine, The University of Florida Health Science Center/Jacksonville, Jacksonville, FL 32209, USA. david.coultas@jax.ufl.edu
Frederick
Jenn
J
Barnett
Bethany
B
Singh
Gaumita
G
Wludyka
Peter
P
D000368:Aged; D003152:Community Health Nursing; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D017533:Marital Status; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000451:nursing* / Q000534:rehabilitation; D019145:Rehabilitation Nursing; D015203:Reproducibility of Results; D012648:Self Care; D012907:Smoking / Q000453:epidemiology