title: Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases.
abstract: OBJECTIVE
  To investigate the effect of a primary care model for COPD on process of care and patient outcome.
  
  
  METHODS
  Controlled study with delayed intervention in control group.
  
  
  METHODS
  The GP delegates tasks to a COPD support service (CSS) and a practice nurse. The CSS offers logistic support to the practice through a patient register and recall system for annual history-taking and lung function measurement. It also forms the link with the chest physician for diagnostic and therapeutic advice. The practice nurse's most important tasks are education and counselling.
  
  
  METHODS
  A total of 44 practices (n =22 for intervention and n =22 for control group) and 260 of their patients > or = 40 years with obstructive lung diseases.
  
  
  RESULTS
  Within the intervention group planned visits increased from 16% to 44% and from 19% to 25% in the control condition (difference between groups p =0.014). Annual lung function measurement rose from 17% to 67% in the intervention and from 11% to 18% in the control group (difference between groups p =0.001). Compared with control, more but not statistically significant smokers received periodic advice to quit smoking (p =0.16). At baseline 41% of the intervention group were using their inhalers correctly and this increased to 54% after two years; it decreased in the control group from 47 to 29% (difference between groups p =0.002). The percentage of patients without exacerbation did not change significantly compared with the control condition. The percentage of the intervention group not needing emergency medication rose from 79% to 84% but decreased in the controls from 81 to 76% (difference between groups p =0.08).
  
  
  CONCLUSIONS
  Combining different disciplines in one model has a positive effect on compliance with recommendations for monitoring patients, and improves the care process and some patient outcomes.
authors.affiliation: Centre for Quality of Care Research (WOK), University Medical Centre Nijmegen, The Netherlands. m.meulepas@kwazo.umcn.nl
authors.forename: Marianne A
authors.initials: MA
authors.lastname: Meulepas
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Jacobs
authors.forename: Frank W J M
authors.initials: FW
authors.lastname: Smeenk
authors.forename: Ivo
authors.initials: I
authors.lastname: Smeele
authors.forename: Annelies E M
authors.initials: AE
authors.lastname: Lucas
authors.forename: Ben J A M
authors.initials: BJ
authors.lastname: Bottema
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000451:nursing / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D005194:Family Practice / Q000458:organization & administration*; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D011320:Primary Health Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000451:nursing / Q000628:therapy*; D012017:Referral and Consultation; D016540:Smoking Cessation; D011795:Surveys and Questionnaires