The effects of patient education in COPD in a 1-year follow-up randomised, controlled trial

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Abstract

The aims were to explore the effects and health economic consequences of patient education in patients with COPD in a 12-month follow-up. Sixty-two patients with mild to moderate Chronic Obstructive Pulmonary Disease (COPD) were at our out-patient clinic randomly allocated to an intervention group or a control group. The intervention group participated in a 4 h group patient education, followed by one to two individual nurse- and physiotherapist-sessions. Self-management was emphasised following a stepwise treatment plan. Effectiveness was expressed in terms of number of general practitioner (GP) consultations, proportions in need of GP consultations, utilisation of rescue medication and patient satisfaction. Costs related to doctor visits, days off work, dispensed pharmaceuticals, hospital admissions, travel costs, educational and time costs were recorded. Patient education reduced the need for GP visits with 85% (from 3.4 to 0.5, P<0.001) and kept a greater proportion independent of their GP during the 12-month follow-up, compared with no education (73% versus 15%, respectively). Patient education reduced the need for reliever medication from 290 to 125 Defined Daily Dosages (DDD), and improved patient satisfaction with overall handling of their disease at GP. The control and intervention groups induced mean total costs of NOK 19 900 and 10 600 per patient, respectively. For every NOK put into patient education, there was a saving of 4.8. The Number Needed to Educate (NNE) to make one person satisfied with their GP was 4.5 and associated with a concomitant saving of NOK 41 900. Patient education of patients with COPD improved patient outcomes and reduced costs in a 12-month follow-up.

Introduction

There has been an increase in morbidity and mortality due to Chronic Obstructive Pulmonary Disease (COPD) in the western world through the last decades [1]. The world-wide prevalence of COPD in 1990 was estimated at 9.34/1000 in men and 7.33/1000 in women [1]. The calculated total costs of COPD in the US in 1993 was US$ 23.9 billion [1].

COPD is both chronic and incurable. In the absence of cure, treatment is directed towards reducing frequency and severity of acute exacerbations and minimising the effect of the disease on the patients’ health. The effects of patient education in asthma is well established [2], [3] and has recently been reported by our group to improve quality of life, lung function [4] and steroid inhaler compliance [5], to reduce the need for general practitioner (GP) visits and absenteeism from work [6] and to be cost-effective [7]. Prior to our study, there were no randomised controlled trials available reporting neither the effect nor the costs of patient education and self-management in patients with COPD. This situation is still unchanged. Reports are lacking on the effects of patient education alone, without standard rehabilitation in patients with COPD [8].

The objectives of the present study were to examine the effect and cost-effectiveness of patient education and self-management on patients with COPD.

This paper summarises the effectiveness outcomes of patient education and self-management in COPD in referral to previous papers from the same trial [4], [5], [6], [9], [10] were the effects of patient education in COPD usually were presented in conjunction with asthma.

Section snippets

Methods

This section of the study is previously described in detail [4], [5], [6], [9]. We here summarise only some of the core methodological aspects and assumptions.

Between May 1, 1994 and December 1, 1995, a total of 62 consecutive patients with COPD were included in the study. Before randomisation they had received ordinary consultation care at our out-patient chest clinic at Central Hospital of Vest-Agder, Kristiansand, Norway. Eligible subjects were patients with COPD, <70 years of age, not

Results

In the control group four patients were withdrawn (lack of co-operation (n=2), diagnosis of rectal cancer (n=1) and emigration (n=1)). Two of the withdrawn control group patients were hospitalised for exacerbations of their COPD. This left us with 27 patients (84%) for the 1-year follow-up.

In the intervention group, four patients failed to complete the educational program (social problems (n=1), unannounced emigration (n=1), failure to meet at educational group sessions for unknown reasons (n

Discussion and conclusion

Our study showed that patient education emphasising self-management and control of exacerbations in patients with COPD, reduced the need for short-acting β2-agonist inhalations as rescue medication by more than 50%. Further, patient education reduced the need for GP visits and kept a greater proportion of patients independent of their GPs. Before given structured patient education, equal and high proportions of patients with COPD were satisfied with both their GPs and the out-patient clinic.

Acknowledgements

This work is supported by Norwegian Medical Association’s Fund for Quality Improvement.

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