title: Feasibility and effectiveness of an asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results.
abstract: BACKGROUND
  In 2007, an Asthma/chronic obstructive pulmonary disease (COPD) (AC) service was implemented in the North of the Netherlands to support General Practitioners (GPs) by providing advice from pulmonologists on a systematic basis.
  
  
  OBJECTIVE
  To evaluate the feasibility and effectiveness of this service on patient-related outcomes.
  
  
  METHODS
  We report baseline data on 11,401 patients and follow-up data from 2,556 patients. GPs can refer all patients with possible obstructive airway disease (OAD) to the service, which is conducted by the local laboratory. Patients are assessed in the laboratory using questionnaires and spirometry. Pulmonologists inspect the data through the internet and send the GP diagnosis and management advice.
  
  
  RESULTS
  A total of 11,401 patients were assessed by the service, covering almost 60% of all adult patients with projected asthma or COPD in the area. In all, 46% (n = 5,268) of the patients were diagnosed with asthma, 18% (n = 2,019) with COPD and 7% (n = 788) with the overlap syndrome. A total of 740 (7%) patients were followed up after 3 months because the GP advised them to change medication. In this group, the proportion of unstable COPD patients (Clinical COPD Questionnaire (CCQ) ⩾ 1) decreased from 63% (n = 92) at baseline to 49% (n = 72). The proportion of patients with uncontrolled asthma (Asthma Control Questionnaire (ACQ) ⩾ 1.5) decreased from 41% (n = 204) to 23% (n = 115). In all, 938 (8%) patients were followed up after 12 months. From these patients, the proportion of unstable COPD patients (CCQ ⩾ 1) decreased from 47% (n = 115) to 44% (n = 107). The proportion of patients with uncontrolled asthma (ACQ⩾1.5) decreased from 16% (n = 95) to 14% (n = 85).
  
  
  CONCLUSIONS
  The AC service assessed a considerable proportion of patients with OAD in the area, improved patients' outcomes, and is considered to be feasible and effective.
authors.affiliation: 1] Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] GRIAC Research Institute Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Esther I
authors.initials: EI
authors.lastname: Metting
authors.affiliation: 1] Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] GRIAC Research Institute Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Roland A
authors.initials: RA
authors.lastname: Riemersma
authors.affiliation: 1] Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] GRIAC Research Institute Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Janwillem H
authors.initials: JH
authors.lastname: Kocks
authors.affiliation: Certe Laboratories, Groningen, The Netherlands.
authors.forename: Margriet G
authors.initials: MG
authors.lastname: Piersma-Wichers
authors.affiliation: 1] Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
authors.affiliation: 1] Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands [2] GRIAC Research Institute Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
mesh_terms: D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D017216:Telemedicine / Q000458:organization & administration*