title: Making collaborative self-management successful in COPD patients with high disease burden.
abstract: BACKGROUND
  Exacerbations in severe COPD patients lead to challenges in terms of self-management. This study is a "real-life" situation aiming to assess whether or not it is possible for COPD patients with high burden of disease to self-manage acute exacerbations and to reduce hospital use.
  
  
  METHODS
  100 randomly selected charts of patients followed in a specialised COPD clinic in 2006 and 2009 (patients with higher burden of disease) were reviewed. Data on patients' characteristics, COPD severity and exacerbation management were extracted.
  
  
  RESULTS
  Compared to the 2006 cohort, patients from the 2009 cohort had lower (0.85 L), but not statistically significant different FEV1 (L) than the 2006 cohort (0.98 L) and more exacerbations (2.6 exacerbations/pt vs 3. 6 exacerbations/pt, p = 0.03). Despite having a higher burden of disease, patients in the 2009 cohort as compared to 2006 had more appropriate self-management behaviours in the event of an exacerbation (60% vs 42%, p = 0.05) and fewer emergency room visits and/or hospital admissions (39% vs 57%, p = 0.02). There were more phone calls to the case managers (590 vs 382, p < 0.001) and fewer physician office visits (167 vs 179, p = 0.024).
  
  
  CONCLUSIONS
  This study of a real life situation adds to the current body of literature that a more severe COPD patient population can be taught self-management skills in the event of exacerbations, leading to fewer health care visits and hospital admissions.
authors.affiliation: Montreal Chest Institute, McGill University Health Centre, Montréal, Québec, Canada. jean.bourbeau@mcgill.ca
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: Nathalie
authors.initials: N
authors.lastname: Saad
authors.forename: Alexandre
authors.initials: A
authors.lastname: Joubert
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ouellet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Drouin
authors.forename: Celia
authors.initials: C
authors.lastname: Lombardo
authors.forename: France
authors.initials: F
authors.lastname: Paquet
authors.forename: Danielle
authors.initials: D
authors.lastname: Beaucage
authors.forename: Michel
authors.initials: M
authors.lastname: Lebel
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D011792:Quebec; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D014797:Vital Capacity / Q000502:physiology