Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial

Nicholas A. Zwar, Jeremy M. Bunker, Helen K. Reddel, Sarah M. Dennis, Sandy Middleton, Onno C.P. van Schayck, Alan J. Crockett, Iqbal Hasan, Oshana Hermiz, Sanjyot Vagholkar, Wei Xuan, Guy B. Marks

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Abstract

Background. Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. Objectives. 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. Methods. 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. Results. 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. Conclusion. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.

Original languageEnglish
Pages (from-to)663-670
Number of pages8
JournalFamily Practice
Volume33
Issue number6
DOIs
Publication statusPublished - 1 Jan 2016
Externally publishedYes

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Chronic Obstructive Pulmonary Disease
Nurses
Quality of Life
Outcome Assessment (Health Care)
Nebulizers and Vaporizers
Bronchodilator Agents
Spirometry
Disease Management
Human Influenza
Lung Diseases
Health Services
Immunization
Patient Care
Appointments and Schedules
Vaccination
Randomized Controlled Trials
Smoking
Control Groups
Surveys and Questionnaires

Cite this

Zwar, N. A., Bunker, J. M., Reddel, H. K., Dennis, S. M., Middleton, S., van Schayck, O. C. P., ... Marks, G. B. (2016). Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial. Family Practice, 33(6), 663-670. https://doi.org/10.1093/fampra/cmw077
Zwar, Nicholas A. ; Bunker, Jeremy M. ; Reddel, Helen K. ; Dennis, Sarah M. ; Middleton, Sandy ; van Schayck, Onno C.P. ; Crockett, Alan J. ; Hasan, Iqbal ; Hermiz, Oshana ; Vagholkar, Sanjyot ; Xuan, Wei ; Marks, Guy B. / Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams : A cluster randomized trial. In: Family Practice. 2016 ; Vol. 33, No. 6. pp. 663-670.
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title = "Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial",
abstract = "Background. Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. Objectives. 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. Methods. 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. Results. 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. Conclusion. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.",
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Zwar, NA, Bunker, JM, Reddel, HK, Dennis, SM, Middleton, S, van Schayck, OCP, Crockett, AJ, Hasan, I, Hermiz, O, Vagholkar, S, Xuan, W & Marks, GB 2016, 'Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams: A cluster randomized trial' Family Practice, vol. 33, no. 6, pp. 663-670. https://doi.org/10.1093/fampra/cmw077

Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams : A cluster randomized trial. / Zwar, Nicholas A.; Bunker, Jeremy M.; Reddel, Helen K.; Dennis, Sarah M.; Middleton, Sandy; van Schayck, Onno C.P.; Crockett, Alan J.; Hasan, Iqbal; Hermiz, Oshana; Vagholkar, Sanjyot; Xuan, Wei; Marks, Guy B.

In: Family Practice, Vol. 33, No. 6, 01.01.2016, p. 663-670.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Early intervention for chronic obstructive pulmonary disease by practice nurse and GP teams

T2 - A cluster randomized trial

AU - Zwar, Nicholas A.

AU - Bunker, Jeremy M.

AU - Reddel, Helen K.

AU - Dennis, Sarah M.

AU - Middleton, Sandy

AU - van Schayck, Onno C.P.

AU - Crockett, Alan J.

AU - Hasan, Iqbal

AU - Hermiz, Oshana

AU - Vagholkar, Sanjyot

AU - Xuan, Wei

AU - Marks, Guy B.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background. Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. Objectives. 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. Methods. 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. Results. 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. Conclusion. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.

AB - Background. Early detection and intervention for chronic obstructive pulmonary disease (COPD) could potentially slow disease progress and minimize harm. Objectives. 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. Methods. 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. Results. 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. Conclusion. Intervention uptake was low and had no additional beneficial effect, over usual care, on participants' health-related QoL.

UR - http://www.scopus.com/inward/record.url?scp=85015030087&partnerID=8YFLogxK

U2 - 10.1093/fampra/cmw077

DO - 10.1093/fampra/cmw077

M3 - Article

VL - 33

SP - 663

EP - 670

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 6

ER -