title: Early detection of COPD in general practice: patient or practice managed? A randomised controlled trial of two strategies in different socioeconomic environments.
abstract: BACKGROUND
  The burden of chronic obstructive pulmonary disease (COPD) is high. Health benefits can be gained in primary care by early detection and preventive measures.
  
  
  OBJECTIVE
  To compare the effectiveness of two strategies for population-based early detection of COPD, taking into account different socioeconomic status (SES) settings.
  
  
  METHODS
  Practices were randomised on strategy and stratified on SES setting. The Respiratory Health Screening Questionnaire (RHSQ) was distributed to all participants. In the practice-managed condition, the practice was responsible for the whole procedure, while in the patient-managed condition, patients were responsible for calculating their RHSQ risk score and applying for a spirometry test. The main outcome measure was the rate of COPD diagnoses after screening.
  
  
  RESULTS
  More new COPD patients were detected in the practice-managed condition (36%) than in the patient-managed condition (18%). In low SES practices, more high-risk patients were found (16%) than in moderate-to-high SES practices (9%). Recalculated for a standard Dutch practice (2,350 patients), the yield would be 8.9 new COPD diagnoses, which is a 20% increase of known cases.
  
  
  CONCLUSIONS
  The practice-managed variant of this screening procedure shows a substantial yield of new COPD diagnoses for both low and moderate-to-high SES practices.
authors: Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Joseph A M
authors: JA
authors: Dirven
authors: Huibert J
authors: HJ
authors: Tange
authors: Jean W M
authors: JW
authors: Muris
authors: Karin M A
authors: KM
authors: van Haaren
authors: Gerrit
authors: G
authors: Vink
authors: Onno C P
authors: OC
authors: van Schayck
mesh_terms: D000328:Adult; D000368:Aged; D059026:Diagnostic Self Evaluation; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D018570:Risk Assessment / Q000379:methods; D012923:Social Class; D013147:Spirometry / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
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