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Background: It is important to understand the experiences surrounding smoking cessation among patients with chronic obstructive pulmonary disease (COPD) to improve the likely success of future smoking cessation programs.Objective: To explore the personal experiences surrounding smoking cessation among general practice patients with COPD.Methods: A purposive sample of 33 general practice patients with COPD, 28 ex-smokers and 5 smokers, participated in the semi-structured telephone interviews. Thematic analysis was conducted using a predominantly deductive approach guided by the Behaviour Change Wheel framework.Results: Three inter-related themes were generated: the motivation, opportunities and capabilities among the participants to quit and maintain smoking cessation. Most quit attempts occurred without explanation or prior planning, though some attempts were motivated by the participants' family, peers or GP. Internet-based smoking cessation support programs led by general practices and involving the practice nurse were perceived as opportunities to engage in quit attempts. Most participants, both ex-smokers and smokers, demonstrated capacity to engage in multiple quit attempts. However, for many smokers, boredom, mood disturbances, the strong sense of identity as a smoker, peer reinforcement, irritability, cravings, hunger and weight gain limited capability to maintain smoking cessation.Conclusions: Patients with COPD have motivation to quit and have demonstrated capacity to engage in multiple quit attempts. GPs and other primary care practitioners need to recognize the patients' spontaneity around quit attempts and to meet the needs of the individual patient by being ready to offer support for each attempt once the patient has made their decision to quit. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design: A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George's Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients' randomization groups. Discussion: This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. [ABSTRACT FROM AUTHOR]

The authors discuss their study of the predictors of accuracy of clinical diagnosis of chronic obstructive pulmonary disease (COPD) in general practice in Sydney, New South Wales. They recruited 56 general practitioners from 44 practices who were asked to complete a questionnaire that covered characteristics of themselves and their practices associated with agreement between clinical and spirometric diagnoses. They found that age of older patients was related to correct diagnosis.

Background: Chronic obstructive pulmonary disease (COPD) is a significant health problem worldwide. This randomised controlled trial aims at testing a new approach that involves a registered nurse working in partnership with patients, general practitioners (GPs) and other health professionals to provide care to patients according to the evidencebased clinical practice guidelines. The aim is to determine the impact of this partnership on the quality of care and patient outcomes. Methods: A cluster randomised control trial design was chosen for this study. Randomisation occurred at practice level. GPs practising in South Western Sydney, Australia and their COPD patients were recruited for the study. The intervention was implemented by nurses specifically recruited and trained for this study. Nurses, working in partnership with GPs, developed care plans for patients based on the Australian COPDX guidelines. The aim was to optimise patient management, improve function, prevent deterioration and enhance patient knowledge and skills. Control group patients received 'usual' care from their GPs. Data collection includes patient demographic profiles and their co-morbidities. Spirometry is being performed to assess patients' COPD status and CO analyser to validate their smoking status. Patients' quality of life and overall health status are being measured by St George's Respiratory Questionnaire and SF-12 respectively. Other patient measures being recorded include health service use, immunisation status, and knowledge of COPD. Qualitative methods will be used to explore participants' satisfaction with the intervention and their opinion about the value of the partnership. Analysis: Analysis will be by intention to treat. Intra-cluster (practice) correlation coefficients will be determined and published for all primary outcome variables to assist future research. The effect of the intervention on outcomes measured on a continuous scale will be estimated and tested using mixed model analysis of variance in which time and treatment group will be fixed effects and GP practice and subject nested within practice will be random effects. The effect of the intervention on the dichotomous variables (such as smoking status, patient knowledge) will be analysed using generalised estimating equations with a logistic link and a model structure that is analogous to that described above. Trial registration: ACTRN012606000304538 [ABSTRACT FROM AUTHOR]

Abstract Objectives: To evaluate usefulness of limited community based care for patients with chronic obstructive pulmonary disease after discharge from hospital. Design: Randomised controlled trial. Setting: Liverpool Health Service and Macarthur Health Service in outer metropolitan Sydney between September 1999 and July 2000. Participants: 177 patients randomised into an intervention group (84 patients) and a control group (93 patients) which received current usual care. Interventions: Home visits by community nurse at one and four weeks after discharge and preventive general practitioner care. Main outcome measures: Frequency of patients' presentation and admission to hospital; changes in patients' disease-specific quality of life, measured with St George's respiratory questionnaire, over three months after discharge; patients' knowledge of illness, self management, and satisfaction with care at discharge and three months later; frequency of general practitioner and nurse visits and their satisfaction with care. Results: Intervention and control groups showed no differences in presentation or admission to hospital or in overall functional status. However, the intervention group improved their activity scores and the control group worsened their symptom scores. While intervention group patients received more visits from community nurses and were more satisfied with their care, involvement of general practitioners was much less (with only 31% (22) remembering receiving a care plan). Patients in the intervention group had higher knowledge scores and were more satisfied. There were no differences in general practitioner visits or management. Conclusions: This brief intervention after acute care improved patients' knowledge and some aspects of quality of life. However, it failed to prevent presentation and readmission to hospital. [ABSTRACT FROM AUTHOR]