title: Patient self-management in primary care patients with mild COPD - protocol of a randomised controlled trial of telephone health coaching.
abstract: BACKGROUND
  The prevalence of diagnosed chronic obstructive pulmonary disease (COPD) in the UK is 1.8%, although it is estimated that this represents less than half of the total disease in the population as much remains undiagnosed. Case finding initiatives in primary care will identify people with mild disease and symptoms. The majority of self-management trials have identified patients from secondary care clinics or following a hospital admission for exacerbation of their condition. This trial will recruit a primary care population with mild symptoms of COPD and use telephone health coaching to encourage self-management.
  
  
  METHODS
  In this study, using a multi-centred randomised controlled trial (RCT) across at least 70 general practices in England, we plan to establish the effectiveness of nurse-led telephone health coaching to support self-management in primary care for people who report only mild symptoms of their COPD (MRC grade 1 and 2) compared to usual care. The intervention focuses on taking up smoking cessation services, increasing physical activity, medication management and action planning and is underpinned by behavioural change theory. In total, we aim to recruit 556 patients with COPD confirmed by spirometry with follow up at six and 12 months. The primary outcome is health related quality of life using the St Georges Respiratory Questionnaire (SGRQ). Spirometry and BMI are measured at baseline. Secondary outcomes include self-reported health behaviours (smoking and physical activity), physical activity measured by accelerometery (at 12 months), psychological morbidity, self-efficacy and cost-effectiveness of the intervention. Longitudinal qualitative interviews will explore how engaged participants were with the intervention and how embedded behaviour change was in every day practices.
  
  
  CONCLUSIONS
  This trial will provide robust evidence about the effectiveness of a novel telephone health coaching intervention to promote behaviour change and prevent disease progression in patients with mild symptoms of dyspnoea in primary care.
  
  
  BACKGROUND
  Current controlled trials ISRCTN06710391 .
authors.affiliation: Research Fellow, Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. m.s.sidhu@bham.ac.uk.
authors.forename: Manbinder S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. a.daley@bham.ac.uk.
authors.forename: Amanda
authors.initials: A
authors.lastname: Daley
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. r.jordan@bham.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jordan
authors.affiliation: Centre for Primary Care: Institute of Population Health, University of Manchester, Manchester, UK. Peter.A.Coventry@manchester.ac.uk.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Coventry
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. carl.heneghan@phc.ox.ac.uk.
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Birmingham, UK. s.jowett@bham.ac.uk.
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Department of Cardiac and Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK. sally.singh@uhl-tr.nhs.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. J.L.Marsh@bham.ac.uk.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Marsh
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. p.adab@bham.ac.uk.
authors.forename: Peymane
authors.initials: P
authors.lastname: Adab
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. j.varghese@bham.ac.uk.
authors.forename: Jinu
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. david.nunan@phc.ox.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Nunan
authors.affiliation: Centre for Primary Care: Institute of Population Health, University of Manchester, Manchester, UK. amy.blakemore@manchester.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Blakemore
authors.affiliation: Primary Care Research Network Central England, Telford, UK. jenny.stevens@telfordccg.nhs.uk.
authors.forename: Jenny
authors.initials: J
authors.lastname: Stevens
authors.affiliation: Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK. leedowson@nhs.net.
authors.forename: Lee
authors.initials: L
authors.lastname: Dowson
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. d.a.fitzmaurice@bham.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Fitzmaurice
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. c.b.jolly@bham.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003376:Counseling / Q000379:methods*; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D004739:England; D006801:Humans; D009043:Motor Activity; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods; D012720:Severity of Illness Index; D016540:Smoking Cessation; D013689:Telephone
chemical_list: D001993:Bronchodilator Agents