The Experts below are selected from a list of 22770 Experts worldwide ranked by ideXlab platform

Niels H Chavannes - One of the best experts on this subject based on the ideXlab platform.

  • exploring characteristics of copd patients with clinical improvement after Integrated Disease Management or usual care post hoc analysis of the recode study
    BMC Pulmonary Medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Apostolos Tsiachristas, M.p.h.m. Rutten-van Mölken, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    BACKGROUND: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. METHOD: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. RESULTS: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). CONCLUSIONS: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. TRIAL REGISTRATION: Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    BMC pulmonary medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2019
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .

  • High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design.
    Journal of medical Internet research, 2017
    Co-Authors: Esther Talboom-kamp, Marise J. Kasteleyn, Noortje A Verdijk, Lara M Harmans, I. J. S. H. Talboom, Mattijs E Numans, Niels H Chavannes
    Abstract:

    Background: Worldwide, nearly 3 million people die of chronic obstructive pulmonary Disease (COPD) every year. Integrated Disease Management (IDM) improves Disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-Management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM in several settings, but it remains unknown which factors influence usage of eHealth and change in behavior of patients. Objective: Our study, e-Vita COPD, compares different levels of integration of Web-based self-Management platforms in IDM in three primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-Management platform for COPD patients. Methods: The e-Vita COPD study compares three different approaches to incorporating eHealth via Web-based self-Management platforms into IDM of COPD using a parallel cohort design. Three groups Integrated the platforms to different levels. In groups 1 (high integration) and 2 (medium integration), randomization was performed to two levels of personal assistance for patients (high and low assistance); in group 3 there was no integration into Disease Management (none integration). Every visit to the e-Vita and Zorgdraad COPD Web platforms was tracked objectively by collecting log data (sessions and services). At the first log-in, patients completed a baseline questionnaire. Baseline characteristics were automatically extracted from the log files including age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ), dyspnea scale (MRC), and quality of life questionnaire (EQ5D). To predict the use of the platforms, multiple linear regression analyses for the different independent variables were performed: integration in IDM (high, medium, none), personal assistance for the participants (high vs low), educational level, and self-efficacy level (General Self-Efficacy Scale [GSES]). All analyses were adjusted for age and gender. Results: Of the 702 invited COPD patients, 215 (30.6%) registered to a platform. Of the 82 patients in group 1 (high integration IDM), 36 were in group 1A (personal assistance) and 46 in group 1B (low assistance). Of the 96 patients in group 2 (medium integration IDM), 44 were in group 2A (telephone assistance) and 52 in group 2B (low assistance). A total of 37 patients participated in group 3 (no integration IDM). In all, 107 users (49.8%) visited the platform at least once in the 15-month period. The mean number of sessions differed between the three groups (group 1: mean 10.5, SD 1.3; group 2: mean 8.8, SD 1.4; group 3: mean 3.7, SD 1.8; P=.01). The mean number of sessions differed between the high-assistance and low-assistance groups in groups 1 and 2 (high: mean 11.8, SD 1.3; low: mean 6.7, SD 1.4; F1,80=6.55, P=.01). High-assistance participants used more services (mean 45.4, SD 6.2) than low-assistance participants (mean 21.2, SD 6.8; F1,80=6.82, P=.01). No association was found between educational level and usage and between GSES and usage. Conclusions: Use of a self-Management platform is higher when participants receive adequate personal assistance about how to use the platform. Blended care, where digital health and usual care are Integrated, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. Trial Registration: Nederlands Trial Register NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6qO1hqiJ1) [J Med Internet Res 2017;19(5):e185]

Annemarije L. Kruis - One of the best experts on this subject based on the ideXlab platform.

  • exploring characteristics of copd patients with clinical improvement after Integrated Disease Management or usual care post hoc analysis of the recode study
    BMC Pulmonary Medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Apostolos Tsiachristas, M.p.h.m. Rutten-van Mölken, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    BACKGROUND: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. METHOD: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. RESULTS: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). CONCLUSIONS: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. TRIAL REGISTRATION: Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    BMC pulmonary medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2019
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .

  • Effectiveness of Integrated Disease Management for primary care chronic obstructive pulmonary Disease patients: results of cluster randomised trial.
    BMJ (Clinical research ed.), 2014
    Co-Authors: Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Jacobijn Gussekloo, Apostolos Tsiachristas, Theo Stijnen, Coert Blom, Jacob K. Sont, M.p.h.m. Rutten-van Mölken, Nicolas Chavannes
    Abstract:

    To investigate the long term effectiveness of Integrated Disease Management delivered in primary care on quality of life in patients with chronic obstructive pulmonary Disease (COPD) compared with usual care. 24 month, multicentre, pragmatic cluster randomised controlled trial 40 general practices in the western part of the Netherlands Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating Integrated Disease Management in practice, including early recognition of exacerbations and self Management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate Integrated Disease Management into daily practice. The control group continued usual care (based on international guidelines). The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self Management, physical activity, and level of Integrated care (PACIC) were also assessed as secondary outcomes. Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference -0.01, 95% confidence interval -0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain "follow-up/coordination" (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain. In this pragmatic study, an Integrated Disease Management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of Integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system. Netherlands Trial Register NTR2268. © Kruis et al 2014.

Apostolos Tsiachristas - One of the best experts on this subject based on the ideXlab platform.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    BMC pulmonary medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • exploring characteristics of copd patients with clinical improvement after Integrated Disease Management or usual care post hoc analysis of the recode study
    BMC Pulmonary Medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Apostolos Tsiachristas, M.p.h.m. Rutten-van Mölken, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    BACKGROUND: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. METHOD: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. RESULTS: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). CONCLUSIONS: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. TRIAL REGISTRATION: Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2019
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .

  • Effectiveness of Integrated Disease Management for primary care chronic obstructive pulmonary Disease patients: results of cluster randomised trial.
    BMJ (Clinical research ed.), 2014
    Co-Authors: Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Jacobijn Gussekloo, Apostolos Tsiachristas, Theo Stijnen, Coert Blom, Jacob K. Sont, M.p.h.m. Rutten-van Mölken, Nicolas Chavannes
    Abstract:

    To investigate the long term effectiveness of Integrated Disease Management delivered in primary care on quality of life in patients with chronic obstructive pulmonary Disease (COPD) compared with usual care. 24 month, multicentre, pragmatic cluster randomised controlled trial 40 general practices in the western part of the Netherlands Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating Integrated Disease Management in practice, including early recognition of exacerbations and self Management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate Integrated Disease Management into daily practice. The control group continued usual care (based on international guidelines). The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self Management, physical activity, and level of Integrated care (PACIC) were also assessed as secondary outcomes. Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference -0.01, 95% confidence interval -0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain "follow-up/coordination" (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain. In this pragmatic study, an Integrated Disease Management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of Integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system. Netherlands Trial Register NTR2268. © Kruis et al 2014.

Melinde Boland - One of the best experts on this subject based on the ideXlab platform.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    BMC pulmonary medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • exploring characteristics of copd patients with clinical improvement after Integrated Disease Management or usual care post hoc analysis of the recode study
    BMC Pulmonary Medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Apostolos Tsiachristas, M.p.h.m. Rutten-van Mölken, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    BACKGROUND: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. METHOD: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. RESULTS: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). CONCLUSIONS: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. TRIAL REGISTRATION: Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Effectiveness of Integrated Disease Management for primary care chronic obstructive pulmonary Disease patients: results of cluster randomised trial.
    BMJ (Clinical research ed.), 2014
    Co-Authors: Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Jacobijn Gussekloo, Apostolos Tsiachristas, Theo Stijnen, Coert Blom, Jacob K. Sont, M.p.h.m. Rutten-van Mölken, Nicolas Chavannes
    Abstract:

    To investigate the long term effectiveness of Integrated Disease Management delivered in primary care on quality of life in patients with chronic obstructive pulmonary Disease (COPD) compared with usual care. 24 month, multicentre, pragmatic cluster randomised controlled trial 40 general practices in the western part of the Netherlands Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating Integrated Disease Management in practice, including early recognition of exacerbations and self Management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate Integrated Disease Management into daily practice. The control group continued usual care (based on international guidelines). The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self Management, physical activity, and level of Integrated care (PACIC) were also assessed as secondary outcomes. Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference -0.01, 95% confidence interval -0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain "follow-up/coordination" (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain. In this pragmatic study, an Integrated Disease Management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of Integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system. Netherlands Trial Register NTR2268. © Kruis et al 2014.

  • effectiveness of Integrated Disease Management for primary care chronic obstructive pulmonary Disease patients results of cluster randomised trial
    BMJ, 2014
    Co-Authors: Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Jacobijn Gussekloo, Apostolos Tsiachristas, Theo Stijnen, Coert Blom, Jacob K. Sont, M.p.h.m. Rutten-van Mölken
    Abstract:

    Objective To investigate the long term effectiveness of Integrated Disease Management delivered in primary care on quality of life in patients with chronic obstructive pulmonary Disease (COPD) compared with usual care. Design 24 month, multicentre, pragmatic cluster randomised controlled trial Setting 40 general practices in the western part of the Netherlands Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating Integrated Disease Management in practice, including early recognition of exacerbations and self Management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate Integrated Disease Management into daily practice. The control group continued usual care (based on international guidelines). Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self Management, physical activity, and level of Integrated care (PACIC) were also assessed as secondary outcomes. Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain “follow-up/coordination” (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain. Conclusion In this pragmatic study, an Integrated Disease Management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of Integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system. Trial registration Netherlands Trial Register NTR2268.

  • Cochrane corner: is Integrated Disease Management for patients with COPD effective?
    Thorax, 2014
    Co-Authors: Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Jacobijn Gussekloo, Nynke Smidt, Maureen P.m.h. Rutten-van Mölken, Niels H Chavannes
    Abstract:

    Patients with COPD experience respiratory symptoms, impairments of daily living and recurrent exacerbations. The aim of Integrated Disease Management (IDM) is to establish a programme of different components of care (ie, self-Management, exercise, nutrition) in which several healthcare providers (ie, nurses, general practitioners, physiotherapists, pulmonologists) collaborate to provide efficient and good quality of care. The aim of this Cochrane systematic review was to evaluate the effectiveness of IDM on quality of life, exercise tolerance and exacerbation related outcomes. Searches for all available evidence were carried out in various databases. Included randomised controlled trials (RCTs) consisted of interventions with multidisciplinary (≥2 healthcare providers) and multitreatment (≥2 components) IDM interventions with duration of at least 3 months. Two reviewers independently searched, assessed and extracted data of all RCTs. A total of 26 RCTs were included, involving 2997 patients from 11 different countries with a follow-up varying from 3 to 24 months. In all 68% of the patients were men, with a mean age of 68 years and a mean forced expiratory volume in 1 s (FEV1) predicted value of 44.3%. Patients treated with an IDM programme improved significantly on quality of life scores and reported a clinically relevant improvement of 44 m on 6 min walking distance, compared to controls. Furthermore, the number of patients with ≥1 respiratory related hospital admission reduced from 27 to 20 per 100 patients. Duration of hospitalisation decreased significantly by nearly 4 days.

Eline Meijer - One of the best experts on this subject based on the ideXlab platform.

  • exploring characteristics of copd patients with clinical improvement after Integrated Disease Management or usual care post hoc analysis of the recode study
    BMC Pulmonary Medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Apostolos Tsiachristas, M.p.h.m. Rutten-van Mölken, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    BACKGROUND: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. METHOD: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. RESULTS: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). CONCLUSIONS: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. TRIAL REGISTRATION: Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    BMC pulmonary medicine, 2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Melinde Boland, Willem J. J. Assendelft, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Marise J. Kasteleyn, Annelies E. Van Eeden, Niels H Chavannes
    Abstract:

    The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Netherlands Trial Register, NTR2268. Registered 31 March 2010.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2020
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

  • Exploring characteristics of COPD patients with clinical improvement after Integrated Disease Management or usual care: post-hoc analysis of the RECODE study
    2019
    Co-Authors: Eline Meijer, Annemarije L. Kruis, Apostolos Tsiachristas, Maureen P.m.h. Rutten-van Mölken, Annelies E. Van Eeden, Melinde R.s. Boland, W. J.j. (pim) Assendelft, Marise J. Kasteleyn, Niels H Chavannes
    Abstract:

    Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of Integrated chronic obstructive pulmonary Disease (COPD) Management in primary care (RECODE) showed that Integrated Disease Management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .