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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 ISSN 0959-8146.

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Official URL: https://doi.org/10.1136/bmj.k2241

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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
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
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:
DateEvent
13 June 2018Published
17 April 2018Accepted
Volume: 361
Article Number: k2241
DOI: 10.1136/bmj.k2241
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 18 April 2018
Date of first compliant Open Access: 2 October 2018
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIED[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
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