The effect of integrated care on health status in COPD

Background: Integrated care of respiratory patients has often been advocated. However, the effect on outcome in COPD patients is unclear. Objectives: To describe the effect of advice from an integrated care system on health status in COPD patients. Method: We developed an integrated care system in which pulmonologists provide diagnostic support to the General Practitioner (GP). Patients with respiratory problems complete questionnaires (history, control and Clinical COPD Questionnaire (CCQ)) and visit the laboratory for spirometry. These data are collected and uploaded to a central server. Based on these data without seeing the patient and supported by a decision support system the pulmonologists (n=9) give advice about diagnosis and treatment to the GP (n=250) who treats the patient. Results: From 7877 patients referred to the integrated care system 1331 patients were diagnosed with COPD. In 310 of these patients CCQ data were available both at baseline and follow up (3 months or 1 year). The median CCQ score of the baseline visit (1.1) proved to be significantly different from the median CCQ scores on the second visit (1.0) (Z= -2.48, p=0.013). Improvement of health status ≥ the minimal clinical important difference (MCID) of 0.4 was measured in 27% of patients (n=82). Deteriorated health status ≥ the MCID was reported by 29% of patients (n=91). 44% of patients reported unchanging health status (n=135). Discussion: This integrated care model where the pulmonologist directly advises the GP provided an overall statistical significant improvement of COPD health status. Clinical implications however are unclear