Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care

Annerika H M Slok; Daniel Kotz; Gerard van Breukelen; Niels H Chavannes; Maureen P M H Rutten-van Mölken; Huib A M Kerstjens; Thys van der Molen; Guus M Asijee; P N Richard Dekhuijzen; Sebastiaan Holverda; Philippe L Salomé; Lucas M A Goossens; Mascha Twellaar; Johannes C C M In 't Veen; Onno C P van Schayck

doi:10.1136/bmjopen-2016-011519

Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care

BMJ Open. 2016 Jul 11;6(7):e011519. doi: 10.1136/bmjopen-2016-011519.

Authors

Annerika H M Slok¹, Daniel Kotz², Gerard van Breukelen³, Niels H Chavannes⁴, Maureen P M H Rutten-van Mölken⁵, Huib A M Kerstjens⁶, Thys van der Molen⁷, Guus M Asijee⁸, P N Richard Dekhuijzen⁹, Sebastiaan Holverda¹⁰, Philippe L Salomé¹¹, Lucas M A Goossens⁵, Mascha Twellaar¹, Johannes C C M In 't Veen¹², Onno C P van Schayck¹

Affiliations

¹ Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
² Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
³ Department of Methodology & Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
⁵ Institute for Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands.
⁶ Department of Pulmonary Diseases, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁷ Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁸ Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Foundation PICASSO for COPD, Alkmaar, The Netherlands.
⁹ Department of Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
¹⁰ Lung Foundation Netherlands, Amersfoort, The Netherlands.
¹¹ Huisartsencoöperatie PreventZorg, Bilthoven, The Netherlands.
¹² Department of Pulmonology and SZT Centre of Excellence for Asthma & COPD, Sint Franciscus Vlietland Gasthuis, Rotterdam, The Netherlands.

Abstract

Objective: Assessing 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) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care.

Methods: A pragmatic cluster randomised controlled trial, in 39 Dutch primary care practices and 17 hospitals, with 357 patients with COPD (postbronchodilator FEV1/FVC ratio <0.7) aged ≥40 years, who could understand and read the Dutch language. Healthcare providers were randomly assigned to the intervention or control group. The intervention group applied the ABC tool, which consists of a short validated questionnaire assessing the experienced burden of COPD, objective COPD parameter (eg, lung function) and a treatment algorithm including a visual display and treatment advice. The control group provided usual care. Researchers were blinded to group allocation during analyses. Primary outcome was the number of patients with a clinically relevant improvement in SGRQ score between baseline and 18-month follow-up. Secondary outcomes were the COPD Assessment Test (CAT) and the Patient Assessment of Chronic Illness Care (PACIC; a measurement of perceived quality of care).

Results: At 18-month follow-up, 34% of the 146 patients from 27 healthcare providers in the intervention group showed a clinically relevant improvement in the SGRQ, compared with 22% of the 148 patients from 29 healthcare providers in the control group (OR 1.85, 95% CI 1.08 to 3.16). No difference was found on the CAT (-0.26 points (scores ranging from 0 to 40); 95% CI -1.52 to 0.99). The PACIC showed a higher improvement in the intervention group (0.32 points (scores ranging from 1 to 5); 95% CI 0.14 to 0.50).

Conclusions: This study showed that use of the ABC tool may increase quality of life and perceived quality of care.

Trial registration number: NTR3788; Results.

Keywords: Chronic Obstructive Pulmonary Disease; Communication tool; Disease Management; Patient-centred care; Quality of Life; Shared Decision Making.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cost of Illness*
Female
Health Status*
Hospitalization
Hospitals
Humans
Male
Middle Aged
Netherlands
Patient Satisfaction*
Primary Health Care
Pulmonary Disease, Chronic Obstructive* / therapy
Quality of Health Care
Quality of Life*
Severity of Illness Index*
Surveys and Questionnaires

Grants and funding

NTR/NTR3788/International