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. A presentation on Sustained health system benefits of primary care based integrated disease management for COPD, where the outcome an interrupted time series study was presented, compared healthcare consumption before and after an intervention.
SUMMARY: A comparison of healthcare consumption before versus after introducing the Best Care program showed positive impact on disease trajectory, and reduced COPD related and all-cause ED visits and hospitalization.
To evaluate whether a primary care Integrated Disease Management 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 (see right) (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. Secondary endpoint was all cause hospitalizations and admissions and all-cause ED visits.
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.
Best Care COPD program
The Best Care COPD program 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:
Assessment, education, self-management, medication management, skills training and evaluation
Results
The study found that the monthly rate of COPD related hospitalization 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.
Interrupted time series (ITS)
An interrupted time series (ITS) design involves collecting data consistently before and after an intervention. This means introducing and withdrawing your service, or some part of it, and then seeing if anything changes in the outcome you’re assessing.
Sarah Friberg,
Value and access director
Recommended reading
- 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
References:
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
ID 345-2023-MARK (Sept 2023)