title: Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: a cluster randomized trial.
abstract: Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm.
  
  
  
  To assess the effectiveness of early intervention by a practice nurse-GP team on quality of life (QoL) and process of care in patients with newly diagnosed COPD, compared with usual care. Nurses and GPs in intervention practices were educated to develop and implement disease management plans for COPD.
  
  
  
  A 12-month, multicentre, pragmatic randomized controlled trial with blinded outcome assessment was conducted. Participants were current and former smokers aged 40 to 85 years newly identified as having COPD on post-bronchodilator spirometry. The primary outcome was health-related QoL, assessed with the St George's Respiratory Questionnaire (SGRQ). Secondary outcome measures were other QoL measures, lung function, disease knowledge, smoking and immunization status, inhaler technique and health service use.
  
  
  
  Of the 10 234 patients from 36 practices in Sydney invited to a case-finding appointment, 1641 (16%) attended and 287 (18%) were diagnosed with COPD. Nineteen practices (144 patients) were randomized to the intervention group and 17 practices (110 patients) to the control group. Only 15.3% (n = 22) patients in the intervention group saw the nurse for COPD care following case finding. There was no between-group difference in SGRQ score at follow-up (mean difference -0.21; P = 0.86). Influenza vaccination was higher in the intervention group (OR 2.31: P = 0.035), but there were no other significant between-group differences in outcomes.
  
  
  
  Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia, n.zwar@unsw.edu.au.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Zwar
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Bunker
authors.affiliation: Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.
authors.forename: Helen K
authors.initials: HK
authors.lastname: Reddel
authors.affiliation: Faculty of Health Sciences, University of Sydney, Lidcombe, Australia.|Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Dennis
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Darlinghurst, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Research School Caphri, Maastricht University, Maastricht, The Netherlands.
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
authors.affiliation: School of Health Sciences, University of South Australia, Adelaide, Australia.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Crockett
authors.affiliation: Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Hasan
authors.affiliation: Centre for Primary Health Care and Equity, UNSW Australia, UNSW Sydney, Australia.
authors.forename: Oshana
authors.initials: O
authors.lastname: Hermiz
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, UNSW Sydney, Australia.
authors.forename: Sanjyot
authors.initials: S
authors.lastname: Vagholkar
authors.affiliation: Ingham Institute for Applied Medical Research, Liverpool, Australia and.
authors.forename: Wei
authors.initials: W
authors.lastname: Xuan
authors.affiliation: Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.|South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia.
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
mesh_terms: D000368:Aged; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005260:Female; D005541:Forced Expiratory Volume; D058006:General Practice / Q000193:education* / Q000379:methods / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009740:Nursing Staff / Q000193:education*; D010347:Patient Care Planning; D010348:Patient Care Team; D010819:Physician's Role; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D016037:Single-Blind Method; D012907:Smoking; D014611:Vaccination / Q000706:statistics & numerical data; D014797:Vital Capacity
keywords: Chronic disease; nursing; primary care; quality of care; respiratory diseases; smoking/tobacco use.