A disease specific self-management intervention reduces hospital utilization in patients with COPD : the effect remains at 2 years

It has recently been demonstrated that a continuum of self-management (SM) for COPD patients provided by a trained health professional significantly reduce the utilisation of health care services (Bourbeau et al Arch Intern Med March 2003). The objective of the present study was to assess in COPD patients who received a self-management program of the beneficial effect of reduce hospitalisation could be maintained at long term. A multicentre, randomised clinical trial was carried out in 191 COPD patients from 7 hospitals. Patients who all had one hospitalisation in the year preceding study enrolment were assigned to a self-management program or to usual care. The self-management program "Living Well with COPD(c)" consisted of a multi-component patient education program administered through weekly visits by trained health professionals over a 2 months period with monthly telephone follow-up for 12 months. All cause hospitalisations, the main outcome, were marked using the provincial hospital database (MED-ECHO).Most patients were elderly, not highly educated and had advanced COPD reflected by a mean FEV1 of 1L and 46% reported a dyspnea score of 5/5 (modified MRC).The long-term effectiveness of the self-management program was assessed with an intention-to-threat analysis. The group-level chi-square analysis shows a statistically significant difference of 29% in the rate of all-cause hospitalization between the intervention group and the usual-care group. The individual-level proportional odds model analysis shows a statistically significant risk estimate of 0.566.The study shows that patients with COPD, who received an education intervention with supervision and support based on disease specific self-management, still had a significant reduction in hospitalisations at 2 years. Within normal practice such program should be an integral part of the continuum of care of patients with COPD