Self-management interventions to improve care of patients with COPD in primary care

Research question: What is the effectiveness of the implementation of a self-management intervention (SMI), using physical and phone-based consultations on patients with chronic obstructive pulmonary disease (COPD), regarding patient-related outcomes, patients’ adherence to medication, their mental health and their general quality of life in primary care units in Crete? Background: SMIs have been developed to facilitate adequate management of COPD, leading to positive effects on patients’ symptoms and quality of life. Recent randomized controlled trials and systematic reviews of COPD-specific SMIs have proven the importance of these interventions. Nevertheless, in most cases the participants are recruited from hospital registers and there is great heterogeneity of outcomes across trials. In Greece there is still no data concerning the implementation of SMIs in adult patients with COPD. Methodology: A randomized-controlled, single blind study with parallel group design comparing a COPD self-management educational program with usual care in primary care units in Heraklion Crete will be conducted. The intervention will be based on a self-management manual, alongside weekly phone-based meetings with participants. At baseline, patients’ symptoms (Modified Medical Research Council Dyspnea scale/mMRC, 6-minute walk test/6MWT, COPD Assessment Test/CAT), the number of exacerbations, Test of Adherence to Inhalers (TAI), patients’ mental health (Patient Health Questionnaire-9/PHQ-9, Generalized Anxiety Disorder 7-item/GAD-7) and their quality of life (36-Item Short Form Survey/SF-36) will be evaluated. The above parameters will be re-evaluated after 6 weeks of using the manual and after 6 months. Questions to discuss: 1. What is the impact of a manual-based SMI on patient outcomes? 2. What is the long-term effect of such interventions? 3. Is it possible to integrate such interventions into usual care? Key words: COPD; patients; SMIs; integrated care; quality of life