Chronic Obstructive Pulmonary Disease (COPD) Clinical Trial
Official title:
COPD Integrated Care Program Valais - Living Well With COPD, a Pilot Study Assessing Feasibility, Acceptability and Effectiveness in the Canton of Valais, Switzerland
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory
disorder characterized by acute exacerbations that contribute to physical impairment and
increased healthcare use and costs. Given the increasing burden of this disease in terms of
morbidity, disability, mortality and costs, innovative care models centered on patients and
aiming at improving quality and comprehensiveness of care are needed. Effective
implementation and evaluation of chronic disease management - integrated care(CDM-IC)
programs, in the real world context is of great importance.
Aim of the pilot study: To conduct a pilot study assessing the acceptability, feasibility
and effectiveness of a community-based CDM-IC program for COPD patients residing in the
canton of Valais.
Design: The evaluation plan of this study will combine both quantitative (controlled
before-after study design) and qualitative methods (focus groups with COPD patients and
practicing healthcare professionals).
Setting: French-speaking part of the canton of Valais.
Patients: 50 adult (>35 years) COPD patients GOLD stage I (symptomatic) - IV of the disease,
non-institutionalized and residing in the canton of Valais. The control group of patients
will be constituted of age and gender-matched COPD patients from the Swiss COPD cohort
study.
Measures:
Quantitative part:
Primary outcomes: Generic and disease-specific health-related quality-of-life and all-cause
hospitalizations (past 12 months)
Other outcomes:
1. Processes of care
2. Patients' assessment of how care is congruent with the Chronic Care Model (PACIC
instrument)
3. Measure of self-efficacy (intermediary outcome)
4. 6-minutes walking test, nb of COPD exacerbations, % of current smokers
5. Healthcare utilization: unscheduled ambulatory care visits
6. Care satisfaction
7. Measures of the process of implementation of the intervention
Qualitative part: At 12 months: conduct of two focus groups of participating COPD patients,
and of two focus groups of participating healthcare professionals.
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory
disorder characterized by acute exacerbations that contribute to physical impairment and
increased healthcare use and costs. Given the increasing burden of this disease in terms of
morbidity, disability, mortality and costs, innovative care models centered on patients and
aiming at improving quality and comprehensiveness of care are needed. Effective
implementation and evaluation of chronic disease management - integrated care(CDM-IC)
programs, in the real world context is of great importance.
Aim of the pilot study: To conduct a pilot study assessing the acceptability, feasibility
and effectiveness of a community-based CDM-IC program for COPD patients residing in the
canton of Valais.
Design: The evaluation plan of this study will combine both quantitative and qualitative
methods. A controlled before-after study design will be considered for the quantitative part
of the project, and the qualitative part will include the conduct of focus groups with COPD
patients and practicing healthcare professionals.
Setting: French-speaking part of the canton of Valais.
Patients: 50 adult (>35 years) COPD patients GOLD stage I (symptomatic) - IV of the disease,
aged > 35 years, non-institutionalized and residing in the canton of Valais. Patients will
be recruited by primary care and pulmonary care physicians practicing in the French-speaking
part of the canton of Valais. The control group of patients will be constituted of age and
gender-matched COPD patients already included in the Swiss COPD cohort study.
Measures:
Quantitative part:
Primary outcomes: Generic and disease-specific health-related quality-of-life(Chronic
Respiratory Questionnaire (CRQ), SF-36 and COPD Assessment Test (CAT)) and all-cause
hospitalizations (past 12 months)
Other outcomes:
1. Processes of care (% patients having participated to self-management education
sessions, % patients having received/used the action plan, % patients having received
smoking cessation recommendations, % patients having received advices/participated to
participate to pulmonary rehabilitation, % patients having received influenza
immunization during the past 12 months, % patients receiving appropriate treatment, nb
of consultations with primary care physician/pulmonary care physician/other, nb of
contacts with the hotline)
2. Patients' assessment of how care is congruent with the Chronic Care Model (PACIC
instrument)
3. Measure of self-efficacy (intermediary outcome)
4. Health behaviors, symptoms and physical activity measures: 6-minutes walking test, nb
of COPD exacerbations during past (past 12 months), % of current smokers
5. Healthcare utilization: unscheduled ambulatory care visits
6. Care satisfaction
7. Measures of the process of implementation of the intervention (nb of recruiting
practices and physicians, nb of participating practices and physicians, nb of and
patients, of drop-outs, satisfaction of healthcare professionals towards COPD program)
Qualitative part: conduct of two focus groups of participating COPD patients, and of two
focus groups of participating healthcare professionals, 12 months after the start of the
recruitment.
Development and implementation of the intervention:
The development of the current COPD program in Valais is being implemented in collaboration
with physicians working in private practices (family physicians and specialists),
physiotherapists, pharmacists and nurse specialists. It will involve academic and public
institutions, as well as practitioners. The program has been launched in March 2013, after a
preliminary phase involving the conduct of focus groups. Their aims were to explore the
needs and barriers to better care, as well as the shape of the targeted CDM elements for
better implementation in real life, from the point of view of COPD patients and healthcare
professionals.
The CDM intervention considered in the "Soins intégrés BPCO en Valais - Mieux vivre avec ma
BPCO" program is based on the " Living well with COPD programme " developed by Prof.
Bourbeau & al at McGill University, Montreal, Canada. The "Soins intégrés BPCO en Valais -
Mieux vivre avec ma BPCO" program will include a combination of patient-related,
professional and organizational elements. It will be centered on patients' needs and focus
on self-management education, proactive follow-up (scheduled visits and/or phone contacts),
team work, healthcare professionals' training, and promotion of pulmonary rehabilitation,
physical activity as well as smoking cessation.
;
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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