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Self management of patients with mild COPD in primary care: randomised controlled trial

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posted on 14.05.2018 by Kate Jolly, Manbinder S. Sidhu, Catherine Hewitt, Peter A. Coventry, Amanda Daley, Rachel Jordan, Carl Heneghan, Sally Singh, Natalie Ives, Peymane Adab, Sue Jowett
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

Funding

This paper summarises independent research funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Sally Singh is part-funded by the CLAHRC-East Midlands.

History

School

  • Sport, Exercise and Health Sciences

Published in

BMJ

Volume

361

Issue

8158

Citation

JOLLY, K. ... et al, 2018. Self management of patients with mild COPD in primary care: randomised controlled trial. BMJ 2018, 361 (8158), k2241.

Publisher

BMJ Publishing Group

Version

VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/

Acceptance date

17/04/2018

Publication date

2018-06-13

Notes

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

ISSN

1756-1833

eISSN

1756-1833

Language

en

Article number

k2241

Licence

Exports