Self-management plans in the primary care of patients with chronic obstructive pulmonary disease.
OBJECTIVE
The role of COPD self-management plans in improving health outcomes remains unclear. The objective of this study was to assess whether self-management plans administered in primary care have beneficial effects on quality of life, self-care behaviour and health outcomes in the long term for patients with COPD.


METHODS
The study was a prospective, unblinded, randomized controlled trial of usual care vs. usual care plus structured education on the use of a written self-management plan and patient-initiated short courses of antibiotics and oral corticosteroids. The study was conducted in general practice, in Christchurch, New Zealand. Participants were 159 patients with COPD randomized by general practice site into control or intervention groups. The primary outcome measure was change in St. George's Respiratory Questionnaire. Secondary variables were frequency of hospital and primary-care attendance, frequency of use of courses of antibiotics and oral corticosteroids over 12 months, and change in Hospital Anxiety and Depression Scale. Self-management knowledge was assessed using a structured interview, the COPD Self-Management Interview.


RESULTS
Self-management plans and structured education were associated with higher levels of self-management knowledge at 12 months, but had no effect on change in St. George's Respiratory Questionnaire, health utilization, mental health or self-reported outcomes of patients with COPD managed in general practice.


CONCLUSIONS
Self-management knowledge was higher in the intervention group but there was no difference in quality of life or health outcomes due to self-management plans.
McGeoch
Graham R B
GR
Pegasus Health, Christchurch, New Zealand.
Willsman
Karen J
KJ
Dowson
Claire A
CA
Town
George I
GI
Frampton
Christopher M
CM
McCartin
Fiona J
FJ
Cook
Julie M
JM
Epton
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001007:Anxiety / Q000150:complications / Q000628:therapy; D003863:Depression / Q000150:complications / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011241:Prednisone / Q000008:administration & dosage; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012648:Self Care / Q000379:methods*
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D011241:Prednisone