PMID- 34495549 OWN - NLM STAT- MEDLINE DCOM- 20211124 LR - 20230216 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 9 IP - 9 DP - 2021 Sep 8 TI - Integrated disease management interventions for patients with chronic obstructive pulmonary disease. PG - CD009437 LID - 10.1002/14651858.CD009437.pub3 [doi] LID - CD009437 AB - BACKGROUND: People with chronic obstructive pulmonary disease (COPD) show considerable variation in symptoms, limitations, and well-being; this often complicates medical care. A multi-disciplinary and multi-component programme that addresses different elements of care could improve quality of life (QoL) and exercise tolerance, while reducing the number of exacerbations. OBJECTIVES: To compare the effectiveness of integrated disease management (IDM) programmes versus usual care for people with chronic obstructive pulmonary disease (COPD) in terms of health-related quality of life (QoL), exercise tolerance, and exacerbation-related outcomes. SEARCH METHODS: We searched the Cochrane Airways Group Register of Trials, CENTRAL, MEDLINE, Embase, and CINAHL for potentially eligible studies. Searches were current as of September 2020. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared IDM programmes for COPD versus usual care were included. Interventions consisted of multi-disciplinary (two or more healthcare providers) and multi-treatment (two or more components) IDM programmes of at least three months' duration. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. If required, we contacted study authors to request additional data. We performed meta-analyses using random-effects modelling. We carried out sensitivity analyses for the quality of included studies and performed subgroup analyses based on setting, study design, dominant intervention components, and region. MAIN RESULTS: Along with 26 studies included in the 2013 Cochrane Review, we added 26 studies for this update, resulting in 52 studies involving 21,086 participants for inclusion in the meta-analysis. Follow-up periods ranged between 3 and 48 months and were classified as short-term (up to 6 months), medium-term (6 to 15 months), and long-term (longer than 15 months) follow-up. Studies were conducted in 19 different countries. The mean age of included participants was 67 years, and 66% were male. Participants were treated in all types of healthcare settings, including primary (n =15), secondary (n = 22), and tertiary care (n = 5), and combined primary and secondary care (n = 10). Overall, the level of certainty of evidence was moderate to high. We found that IDM probably improves health-related QoL as measured by St. George's Respiratory Questionnaire (SGRQ) total score at medium-term follow-up (mean difference (MD) -3.89, 95% confidence interval (CI) -6.16 to -1.63; 18 RCTs, 4321 participants; moderate-certainty evidence). A comparable effect was observed at short-term follow-up (MD -3.78, 95% CI -6.29 to -1.28; 16 RCTs, 1788 participants). However, the common effect did not exceed the minimum clinically important difference (MCID) of 4 points. There was no significant difference between IDM and control for long-term follow-up and for generic QoL. IDM probably also leads to a large improvement in maximum and functional exercise capacity, as measured by six-minute walking distance (6MWD), at medium-term follow-up (MD 44.69, 95% CI 24.01 to 65.37; 13 studies, 2071 participants; moderate-certainty evidence). The effect exceeded the MCID of 35 metres and was even greater at short-term (MD 52.26, 95% CI 32.39 to 72.74; 17 RCTs, 1390 participants) and long-term (MD 48.83, 95% CI 16.37 to 80.49; 6 RCTs, 7288 participants) follow-up. The number of participants with respiratory-related admissions was reduced from 324 per 1000 participants in the control group to 235 per 1000 participants in the IDM group (odds ratio (OR) 0.64, 95% CI 0.50 to 0.81; 15 RCTs, median follow-up 12 months, 4207 participants; high-certainty evidence). Likewise, IDM probably results in a reduction in emergency department (ED) visits (OR 0.69, 95%CI 0.50 to 0.93; 9 RCTs, median follow-up 12 months, 8791 participants; moderate-certainty evidence), a slight reduction in all-cause hospital admissions (OR 0.75, 95%CI 0.57 to 0.98; 10 RCTs, median follow-up 12 months, 9030 participants; moderate-certainty evidence), and fewer hospital days per person admitted (MD -2.27, 95% CI -3.98 to -0.56; 14 RCTs, median follow-up 12 months, 3563 participants; moderate-certainty evidence). Statistically significant improvement was noted on the Medical Research Council (MRC) Dyspnoea Scale at short- and medium-term follow-up but not at long-term follow-up. No differences between groups were reported for mortality, courses of antibiotics/prednisolone, dyspnoea, and depression and anxiety scores. Subgroup analysis of dominant intervention components and regions of study suggested context- and intervention-specific effects. However, some subgroup analyses were marked by considerable heterogeneity or included few studies. These results should therefore be interpreted with caution. AUTHORS' CONCLUSIONS: This review shows that IDM probably results in improvement in disease-specific QoL, exercise capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of IDM components and which intervention duration are most effective for IDM programmes, and should consider contextual determinants of implementation and treatment effect, including process-related outcomes, long-term follow-up, and cost-effectiveness analyses. CI - Copyright (c) 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Poot, Charlotte C AU - Poot CC AD - Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands. FAU - Meijer, Eline AU - Meijer E AD - Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands. FAU - Kruis, Annemarije L AU - Kruis AL AD - Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands. FAU - Smidt, Nynke AU - Smidt N AD - Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. FAU - Chavannes, Niels H AU - Chavannes NH AD - Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands. FAU - Honkoop, Persijn J AU - Honkoop PJ AD - Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands. LA - eng SI - ClinicalTrials.gov/NCT02036294 SI - ClinicalTrials.gov/NCT01241526 SI - ClinicalTrials.gov/NCT01984840 SI - ClinicalTrials.gov/NCT01648621 SI - ClinicalTrials.gov/NCT01543217 SI - ClinicalTrials.gov/NCT02618746 SI - ClinicalTrials.gov/NCT04256070 SI - ClinicalTrials.gov/NCT03183817 SI - ClinicalTrials.gov/NCT02034045 SI - ClinicalTrials.gov/NCT03007485 SI - ClinicalTrials.gov/NCT04136418 SI - ClinicalTrials.gov/NCT04416295 SI - ClinicalTrials.gov/NCT04533412 PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review PT - Systematic Review DEP - 20210908 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - Cochrane Database Syst Rev. 2013 Oct 10;(10):CD009437. PMID: 24108523 MH - Aged MH - Disease Management MH - Dyspnea MH - Exercise Tolerance MH - Humans MH - Male MH - *Pulmonary Disease, Chronic Obstructive/therapy MH - Quality of Life PMC - PMC8425271 COIS- NC is a senior researcher in the field of integrated disease management programmes who is involved in several initiatives promoting education, developing software applications, and providing e-health solutions, which may be considered as a potential conflict of interest. CP: none known. EM: none known. AK: was a PhD student on the RECODE trial, which investigates the effectiveness of integrated care for primary care COPD patients in a cluster-randomised controlled trial in primary care. The Leiden University Medical Centre received a grant from ZonMW (Dutch governmental agency) and additional financial support from Achmea (Dutch Healthcare Insurer) for the RECODE trial. In the future, our RCT will be included in the Cochrane Review. NS: none known. PH: has received payment from E-wise for development of a continuous medical education programme for general practitioners and pharmacists on severe asthma. E-wise does not provide any type of disease management programme. EDAT- 2021/09/09 06:00 MHDA- 2021/11/25 06:00 PMCR- 2022/09/08 CRDT- 2021/09/08 12:33 PHST- 2021/09/08 12:33 [entrez] PHST- 2021/09/09 06:00 [pubmed] PHST- 2021/11/25 06:00 [medline] PHST- 2022/09/08 00:00 [pmc-release] AID - CD009437.pub3 [pii] AID - 10.1002/14651858.CD009437.pub3 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2021 Sep 8;9(9):CD009437. doi: 10.1002/14651858.CD009437.pub3.