Action Plan to enhance self-management and early detection of exacerbations in COPD patients; a multicenter RCT.
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.
Trappenburg
Jaap C A
JC
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
Koevoets
Lieselotte
L
de Weert-van Oene
Gerdien H
GH
Monninkhof
Evelyn M
EM
Bourbeau
Jean
J
Troosters
Thierry
T
Verheij
Theo J M
TJ
Lammers
Jan-Willem J
JW
Schrijvers
Augustinus J P
AJ
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