The Quebec Respiratory Health Education Network: Integrating a model of self-management education in COPD primary care

The objective of this study is to evaluate whether a chronic obstructive pulmonary disease (COPD) self-management education program with coaching of a case manager improves patient-related outcomes and leads to practice changes in primary care. COPD patients from six family medicine clinics (FMCs) p...

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Bibliographic Details
Published in:	Chronic respiratory disease 2018-05, Vol.15 (2), p.103-113
Main Authors:	Bourbeau, Jean, Farias, Raquel, Li, Pei Zhi, Gauthier, Guylaine, Battisti, Livia, Chabot, Valérie, Beauchesne, Marie-France, Villeneuve, Denis, Côté, Patricia, Boulet, Louis-Philippe
Format:	Article
Language:	eng
Subjects:	Adrenal Cortex Hormones - therapeutic use Aged Bronchodilator Agents - therapeutic use Case Management Chronic obstructive pulmonary disease Education Emergency Service, Hospital - statistics & numerical data Family Practice Female Health Knowledge, Attitudes, Practice Health services utilization Health Status Hospitalization - statistics & numerical data Humans Influenza Vaccines - therapeutic use Inhalers Male Medication Adherence - statistics & numerical data Middle Aged Original Papers Patient compliance Patient Education as Topic - methods Patient Reported Outcome Measures Patients Physicians Primary care Primary Health Care Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - physiopathology Quality of Life Quebec Self Care - methods Spirometry
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Summary:	The objective of this study is to evaluate whether a chronic obstructive pulmonary disease (COPD) self-management education program with coaching of a case manager improves patient-related outcomes and leads to practice changes in primary care. COPD patients from six family medicine clinics (FMCs) participated in a 1-year educational program offered by trained case managers who focused on treatment adherence, inhaler techniques, smoking cessation, and the use of an action plan for exacerbations. Health-care utilization, health-related quality of life (HRQL), treatment adherence, inhaler technique, and COPD knowledge were assessed at each visit with validated questionnaires. We also evaluated whether the use of spirometry and the assessment of individual patient needs led to a more COPD-targeted treatment by primary care physicians, based on changes in prescriptions for COPD (medication, immunization, and written action plan). Fifty-four patients completed the follow-up visits and were included in the analysis. The number of unscheduled physician visits went from 40 the year before intervention to 17 after 1 year of educational intervention (p = 0.033). Emergency room visits went from five to two and hospitalizations from two to three (NS). Significant improvements were observed in HRQL (p = 0.0001), treatment adherence (p = 0.025), adequate inhaler technique (p < 0.0001), and COPD knowledge (p < 0.001). Primary care physicians increased their prescriptions for long-acting bronchodilators with/without inhaled corticosteroid, flu immunizations, and COPD action plans in the event patient had an exacerbation. The COPD self-management educational intervention in FMCs reduced unscheduled visits to the clinic and improved patients’ quality of life, self-management skills, and knowledge. The program had a positive impact on COPD-related practices by primary care physicians in the FMCs.
ISSN:	1479-9731 1479-9723 1479-9731