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Self management of patients with mild COPD in primary care: randomised controlled trial
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Jolly, Kate, Sidhu, Manbinder S., Hewitt, Catherine A., Coventry, Peter A., Daley, Amanda, Jordan, Rachel, Heneghan, Carl, Singh, Sally, Ives, Natalie, Adab, Peymane, Jowett, Susan, Varghese, Jinu, Nunan, David, Ahmed, Khaled, Dowson, Lee and Fitzmaurice, David A. (2018) Self management of patients with mild COPD in primary care: randomised controlled trial. British Medical Journal, 361 . k2241. doi:10.1136/bmj.k2241
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Official URL: https://doi.org/10.1136/bmj.k2241
Abstract
Objective
To evaluate the effectiveness of nurse-led telephone health coaching to encourage self-management in a primary care population with mild symptoms of COPD.
Design
Pragmatic, multi-centre randomised controlled trial.
Setting
71 general practices in four areas of England.
Participants
577 people, with MRC dyspnoea grade 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis, were randomised to the intervention (n=289) or usual care (n=288).
Interventions
Nurse-delivered telephone health coaching intervention, underpinned by Social Cognitive Theory, promoting: accessing smoking cessation services, increasing physical activity, medication management and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). Nurses received two days of training. The usual care group received a leaflet about COPD.
Main outcome measures
The primary outcome was health related quality of life at 12 months using the short version of the St Georges Respiratory Questionnaire (SGRQ-C).
Results
The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of participants received all four calls. 92% participants were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95%CI -3.6 to 0.9; p=0.2). Compared to usual care participants, at six months follow-up, the intervention group reported significantly greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%) and inhaler technique check (68% v 55%). There were no differences in other secondary outcomes (dyspnoea, smoking cessation, anxiety, depression, self-efficacy, objectively measured physical activity).
Conclusions
A novel telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self-management activities, but did not improve health related quality of life.
Trial registration
Current controlled trials ISRCTN 06710391
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Lungs -- Diseases, Obstructive, Primary care (Medicine), Clinical trials | ||||||
| Journal or Publication Title: | British Medical Journal | ||||||
| Publisher: | BMJ Group | ||||||
| ISSN: | 0959-8146 | ||||||
| Official Date: | 13 June 2018 | ||||||
| Dates: |
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| Volume: | 361 | ||||||
| Article Number: | k2241 | ||||||
| DOI: | 10.1136/bmj.k2241 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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