title: Action Plan to enhance self-management and early detection of exacerbations in COPD patients; a multicenter RCT.
abstract: BACKGROUND
  Early detection of exacerbations by COPD patients initiating prompt interventions has shown to be clinically relevant. Until now, research failed to identify the effectiveness of a written individualized Action Plan (AP) to achieve this.
  
  
  METHODS
  The current multicenter, single-blind RCT with a follow-up period of 6 months, evaluates the hypothesis that individualized AP's reduce exacerbation recovery time. Patients are included from regular respiratory nurse clinics and allocated to either usual care or the AP intervention. The AP provides individualized treatment prescriptions (pharmaceutical and non-pharmaceutical) related to a color coded symptom status (reinforcement at 1 and 4 months). Although usually not possible in self-management trials, we ensured blinding of patients, using a modified informed consent procedure in which patients give consent to postponed information. Exacerbations in both study arms are defined using the Anthonisen symptom diary-card algorithm. The Clinical COPD Questionnaire (CCQ) is assessed every 3-days. CCQ-recovery time of an exacerbation is the primary study outcome. Additionally, healthcare utilization, anxiety, depression, treatment delay, and self-efficacy are assessed at baseline and 6 months. We aim at including 245 COPD patients from 7 hospitals and 5 general practices to capture the a-priori sample size of at least 73 exacerbations per study arm.
  
  
  CONCLUSIONS
  This RCT identifies if an AP is an effective component of self-management in patients with COPD and clearly differentiates from existing studies in its design, outcome measures and generalizability of the results considering that the study is carried out in multiple sites including general practices.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. j.c.a.trappenburg@umcutrecht.nl
authors.forename: Jaap C A
authors.initials: JC
authors.lastname: Trappenburg
authors.forename: Lieselotte
authors.initials: L
authors.lastname: Koevoets
authors.forename: Gerdien H
authors.initials: GH
authors.lastname: de Weert-van Oene
authors.forename: Evelyn M
authors.initials: EM
authors.lastname: Monninkhof
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Thierry
authors.initials: T
authors.lastname: Troosters
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001007:Anxiety / Q000175:diagnosis; D003863:Depression / Q000175:diagnosis; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method