Sustained health system benefits of primary care based integrated disease management for COPD: an interrupted time series
Severe exacerbations in patients with chronic obstructive pulmonary disease (COPD) is a challenge for both patient and health care system. Methods to prevent exacerbations are therefore needed.
To evaluate whether a primary care integrated disease program (IDM) can reduce health service utilisation, patients with severe COPD were studied in a real-world setting. All individuals managed by the Best Care program (2011-2019, Ontario Canada) with a clinical diagnosis of COPD were included (N=2451, mean age 67 years, female rate 48.3). Primary endpoint was COPD-related hospital admissions and COPD related ED visits, and the secondary endpoint was all cause hospitalizations and admissions and all-cause ED visits.
Best Care COPD is built around a triad of health care stakeholders including the patient/caregiver, the primary care provider, and a certified respiratory educator. The program is located at the primary care provider clinic and consists of a set of structured intervention including:
- medication management
- skills training
Through an interrupted time series analysis of retrospective administrative data, the study assessed the number of COPD-related and all-cause hospital admissions and emergency department (ED) visits 36 month pre- and post IDM program initiation. IDM program patients were linked to administrative health databases in the study amassing 13,000 person years of follow-up. In the year prior to commencing IDM, 9.2% of individuals experienced a total of 383 COPD related hospitalisations, and 20.4% individuals generated 809 COPD-related ED visits.
The study found that the monthly rate of COPD related hospitalisation and ED-visits in 1000 individuals 12 month after program initiation was decrease by 9.1 and 19.0 respectively, corresponding to a relative reduction of 56% and 46%. After 36 months, monthly rate of events per 1000 individuals almost halved.
The study concluded, said presenter Christopher Licskai, that primary care-based COPD IDM program was associated with significantly improved disease trajectory, and reduced COPD related and all-cause ED visits and hospitalisation.
- Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. Report;2023
- Criner GJ, et al. Prevention of acute exacerbations of thoracic obstructive pulmonary disease: American College of Chest Physicians and Canadian Thoriacic Society Guideline. Chest. 2015;147(4):894-942
- Poot CC, Meijer E, Kruis AL, Smidt N, Chavannes NH, Honkoop PJ. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2021;9(9):CD009437. Published 2021 Sep 8. doi:10.1002/14651858.CD009437.pub3
Value and access director
Ferrone M, et al. The impact of integrated disease management in high-risk COPD patients in primary care. Npj Prim Care Respir Med. 2019;29(1):8