title: A COPD health management program in a community-based primary care setting: a randomized controlled trial.
abstract: BACKGROUND
  A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China.
  
  
  METHODS
  A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular follow-up. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits.
  
  
  RESULTS
  After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitalizations due to all causes by 16.1%, and emergency department visits due to all causes by 18.1% (P < .05 for all). However, it increased immunomodulator use by 58.9%, respiratory medication use by 14.1-21.9%, and awareness scores for COPD by 57.2% (P < .05 for all).
  
  
  CONCLUSIONS
  The health management program is an effective community-based strategy for the prevention and management of COPD in China, increasing awareness and knowledge among patients and practitioners and improving management within the limitations of access to pharmacotherapy.
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China. lpa82835415@126.com.
authors.forename: Peian
authors.initials: P
authors.lastname: Lou
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Peipei
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Pan
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Jiaxi
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Na
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors.forename: Hongmin
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology; D015992:Body Mass Index; D001945:Breathing Exercises; D002681:China / Q000453:epidemiology; D003153:Community Health Services; D003863:Depression / Q000209:etiology; D004032:Diet; D037001:Directive Counseling; D004417:Dyspnea / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D015444:Exercise; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D019035:Rural Health Services; D012720:Severity of Illness Index; D016540:Smoking Cessation
chemical_list: D007155:Immunologic Factors
keywords: BODE index; COPD; health management; health status