title: Self-management reduces both short- and long-term hospitalisation in COPD.
abstract: The aim of the present study was to assess the long-term impact on hospitalisation of a self-management programme for chronic obstructive pulmonary disease (COPD) patients. A multicentre, randomised clinical trial was carried out involving 191 COPD patients from seven hospitals. Patients who had one or more hospitalisations in the year preceding study enrolment were assigned to a self-management programme "Living Well with COPD(TM)" or to standard care. Hospitalisations from all causes were the primary outcome and were documented from the provincial hospitalisation database; emergency visits were recorded from the provincial health insurance database. Most patients were elderly, not highly educated, had advanced COPD (reflected by a mean forced expiratory volume in one second of 1 L), and almost half reported a dyspnoea score of 5/5 (modified Medical Research Council). At 2 years, there was a statistically significant and clinically relevant reduction in all-cause hospitalisations of 26.9% and in all-cause emergency visits of 21.1% in the intervention group as compared to the standard-care group. After adjustment for the self-management intervention effect, the predictive factors for reduced hospitalisations included younger age, sex (female), higher education, increased health status and exercise capacity. In conclusion, in this study, patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period.
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, 3650 St Urbain Street, Montréal, Québec, H2X 2P4, Canada.
authors.forename: M-A
authors.initials: MA
authors.lastname: Gadoury
authors.forename: K
authors.initials: K
authors.lastname: Schwartzman
authors.forename: M
authors.initials: M
authors.lastname: Rouleau
authors.forename: F
authors.initials: F
authors.lastname: Maltais
authors.forename: M
authors.initials: M
authors.lastname: Julien
authors.forename: A
authors.initials: A
authors.lastname: Beaupré
authors.forename: P
authors.initials: P
authors.lastname: Renzi
authors.forename: R
authors.initials: R
authors.lastname: Bégin
authors.forename: D
authors.initials: D
authors.lastname: Nault
authors.forename: J
authors.initials: J
authors.lastname: Bourbeau
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy*; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome