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A Disease-Specific Self-management Intervention

Jean Bourbeau, MD; Marcel Julien, MD; François Maltais, MD; Michel Rouleau, MD; Alain Beaupré, MD; Raymond Bégin, MD; Paolo Renzi, MD; Diane Nault, RN; Elizabeth Borycki, RN; Kevin Schwartzman, MD; Ravinder Singh, MSc; Jean-Paul Collet, MD; for the Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Santé du Québec

Arch Intern Med. 2003;163:585-591.

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.

From the Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, and Respiratory Epidemiology Unit, McGill University (Drs Bourbeau and Schwartzman, and Mss Nault and Singh), Hôpital Sacré-Coeur, Centre hospitalier affilié de l'Université de Montréal (Dr Julien), Hôpital Maisonneuve Rosemont, Centre hospitalier affilié de l'Université de Montréal (Dr Beaupré), Hôpital Notre-Dame, Centre hospitalier universitaire de Montréal (Dr Renzi), and Jewish General Hospital, McGill University (Dr Collet), Montreal, Quebec; Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval (Dr Maltais), and Hôpital de l'Enfant-Jésus, centre hospitalier affilié de l'Université Laval (Dr Rouleau), Quebec, Quebec; Centre universitaire de santé de l'Estrie, Sherbrooke, Quebec (Dr Bégin); and Mount Sinai Hospital, Toronto, Ontario (Ms Borycki). A list of the members of the Chronic Obstructive Pulmonary Disease axis of the Respiratory Network, Fonds de al Rechereche en Santé du Quebéc can be found at http://www.rsr.chus.qc.ca/pages/ppen.htm.

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