Systematic review of the effects of chronic disease management on quality-of-life in people with chronic obstructive pulmonary disease.
BACKGROUND
Chronic disease management for patients with chronic obstructive pulmonary disease (COPD) may improve quality, outcomes and access to care.


OBJECTIVE
To investigate effectiveness of chronic disease management programmes on the quality-of-life of people with COPD.


METHODS
Medline and Embase (1995-2005) were searched for relevant articles, and reference lists and abstracts were searched for controlled trials of chronic disease management programmes for patients with COPD. Quality-of-life was assessed as an outcome parameter. Two reviewers independently reviewed each paper for methodological quality and extracted the data.


RESULTS
We found 10 randomized-controlled trials comparing chronic disease management with routine care. Patient populations, health-care professionals, intensity, and content of the intervention were heterogeneous. Different instruments were used to assess quality of life. Five out of 10 studies showed statistically significant positive outcomes on one or more domains of the quality of life instruments. Three studies, partly located in primary care, showed positive results.


CONCLUSIONS
All chronic disease management projects for people with COPD involving primary care improved quality of life. In most of the studies, aspects of chronic disease management were applied to a limited extent. Quality of randomized-controlled trials was not optimal. More research is needed on chronic disease management programmes in patients with COPD across primary and secondary care.
Niesink
A
A
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Trappenburg
J C A
JC
de Weert-van Oene
G H
GH
Lammers
J W J
JW
Verheij
T J M
TJ
Schrijvers
A J P
AJ
D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic