Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-specific self-management intervention

Jean Bourbeau, Marcel Julien, François Maltais, Michel Rouleau, Alain Beaupré, Raymond Bégin, Paolo Renzi, Diane Nault, Elizabeth Borycki, Kevin Schwartzman, Ravinder Singh, Jean Paul Collet

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739 Scopus citations

Abstract

Background: Self-management interventions improve various outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease. Methods: A multicenter, randomized clinical trial was carried out in 7 hospitals from February 1998 to July 1999. All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year. Patients were assigned to a self-management program or to usual care. The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up. Over 12 months, data were collected regarding the primary outcome and number of hospitalizations; secondary outcomes included emergency visits and patient health status. Results: Hospital admissions for exacerbation of COPD were reduced by 39.8% in the intervention group compared with the usual care group (P=.01), and admissions for other health problems were reduced by 57.1% (P=.01). Emergency department visits were reduced by 41.0% (P=.02) and unscheduled physician visits by 58.9% (P=.003). Greater improvements in the impact subscale and total quality-of-life scores were observed in the intervention group at 4 months, although some of the benefits were maintained only for the impact score at 12 months. Conclusions: A continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status. This approach of care can be implemented within normal practice.

Original languageEnglish (US)
Pages (from-to)585-591
Number of pages7
JournalArchives of internal medicine
Volume163
Issue number5
DOIs
StatePublished - Mar 10 2003

ASJC Scopus subject areas

  • Internal Medicine

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    Bourbeau, J., Julien, M., Maltais, F., Rouleau, M., Beaupré, A., Bégin, R., Renzi, P., Nault, D., Borycki, E., Schwartzman, K., Singh, R., & Collet, J. P. (2003). Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-specific self-management intervention. Archives of internal medicine, 163(5), 585-591. https://doi.org/10.1001/archinte.163.5.585