Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study

Anna J Hussey,1 Kevin Wing,2 Madonna Ferrone,1,3 Christopher J Licskai1,4– 6 1Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada; 2London School of Hygiene and Tropical Medicine, London, UK; 3Hotel-Dieu Grace Healthcare, Windsor, ON, Canada; 4London Health Sciences Centre, London, ON, Canada; 5Lawson Health Research Institute, London, ON, Canada; 6Schulich School of Medicine and Dentistry, Western University, London, ON, CanadaCorrespondence: Christopher J LicskaiSchulich School of Medicine and Dentistry, Western University, London, ON, CanadaEmail chris.licskai@sjhc.London.on.caPurpose: Integrated disease management (IDM) for COPD in primary care has been primarily investigated under clinical trial conditions. We previously published a randomized controlled trial (RCT) where the IDM intervention improved quality of life (QoL) and exacerbation-related outcomes. In this study, we assess the same IDM intervention in a real-world evaluation and identify patient characteristics associated with improved outcomes.Methods: This historical cohort study included patients enrolled for 12 (± 3 months) in the Best Care COPD IDM program. The main outcome was a ≥ 3 point improvement in COPD assessment test (CAT). Secondary outcomes were COPD exacerbations requiring antibiotics and/or prednisone, unscheduled physician visits, emergency department visits and hospitalizations.Results: Data for 571 patients (all patients) were included, 158 met the reference RCT eligibility (RCT matched). Improved QoL was observed in 43% (95% CI:38.9,47.2) of all patients, 47% (95% CI:39.5,55.6) of RCT matched vs 92% (95% CI:79.2,95.1) in the reference RCT intervention arm (n=72). Reductions (12 months IDM vs prior year) were observed in the proportion of patients experiencing exacerbation-related events (all patients): antibiotics/prednisone (− 9.0%,95% CI:-13.9,-3.9); unscheduled physician (− 33.1%,95% CI:-38.2,-27.9); emergency department (− 9.6%,95% CI:-13.5,-5); and