A pilot study of identification and case management of high-risk COPD patients in a general practice.
BACKGROUND
A variety of individual therapeutic interventions have been shown to reduce hospital admissions and improve quality of life in patients with chronic obstructive pulmonary disease (COPD). However, there is a paucity of data of looking at the effect of case management in primary care (i.e. using an integrated care approach) of people at higher risk of mortality from COPD.


OBJECTIVE
To examine the effect of case management in primary care of patients with COPD at high risk of hospital admission, identified using a novel multidimensional index of disease severity (DOSE index).


METHODS
Observational pilot study in a single general practice. High-risk patients were identified using the DOSE index and case managed using an IT system according to British National Guidelines over a 6-month period.


RESULTS
Eleven patients entered and completed the study. There was no improvement in health status, but there was a non-significant reduction in total hospital admissions (three versus zero) and total bed days (16 versus 0) compared to the same reference period in the previous year. There was an increase in self-management knowledge.


CONCLUSIONS
Case management of high-risk patients in primary care may reduce hospital admissions. This needs to be tested in a randomized controlled trial.
Gruffydd-Jones
Kevin
K
Box Surgery, Box, Wiltshire, UK. kevin.gruffydd-jones@gp-J83013.nhs.uk
Richman
Jo
J
Jones
Rupert C M
RC
Wang
Xu
X
D000368:Aged; D019090:Case Management / Q000706:statistics & numerical data; D003658:Decision Making, Computer-Assisted; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome