Effectiviteit van de ‘Ziektelastmeter COPD’*

Objective

Assessment of the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD).

Design

Cluster-randomised controlled trial.

Method

This concerned a trial in 39 Dutch primary care practices and 17 hospitals, involving 357 patients with COPD (postbronchodilator FEV₁/FVC ratio < 0.7) aged ≥ 40 years. Healthcare providers were randomized to an intervention or control group. Patients in the intervention group were treated with the ABC tool. This innovative tool consists of a short validated questionnaire and a number of objective parameters, which collectively give a visual overview of the combined integral health; the tool subsequently produces an individualized treatment plan by means of a treatment algorithm. Patients in the control group received usual care. The primary outcome measure was the proportion of patients with a clinically relevant improvement in disease-specific quality of life measured, as measured by means of the St. George’s Respiratory Questionnaire (SGRQ) score, between baseline and 18 months follow-up. Secondary outcomes included the SGRQ total score and the Patient Assessment of Chronic Illness Care (PACIC) score.

Results

At 18-month follow-up, a significant and clinically relevant improvement in the SGRQ score was seen in 34% of the patients (N=49) in the intervention group, and in the control group this figure was 22% (N=33). This difference between the two groups was significant (OR 1.85, 95% CI 1.08 to 3.16). Patients in the intervention group experienced a higher quality of care than patients in the control group (0.32 points difference in PACIC, 95% CI 0.14 to 0.50).

Conclusion

Use of the ABC tool increases the disease-specific quality of life and the quality of care for COPD patients; it may therefore offer a valuable contribution to improvements in the daily care of COPD. Replication of this study in other (non-Dutch) health-care settings is recommended.

Conflict of interest and financial support for this article: O.C.P. van Schayck’s employer has received a research grant from the Dutch Lung Alliance. M.P.M.H. Rutten-van Mölken has received a research grant from Innovation Fund Healthcare Insurers, the Netherlands, honoraria from the Foundation PICASSO for COPD for contributing to the workshop Assessment of Burden of COPD, and grants from GSK, Novartis, Boehringer Ingelheim, Chiesi, Almirall and AstraZeneca for the discrete choice experiment which formed the basis of the disease burden index. ICMJE forms provided by the authors are available online along with the full text of this article.