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Integrated care prevents hospitalisations for exacerbations in COPD patients

¹ Servei de Pneumologia and Technology Innovation Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, ² Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS), Universitat Pompeu Fabra, Barcelona, and ³ Grupo de Bioingeniería y Telemedicina (GBT-UPM), Universidad Politécnica de Madrid, Madrid, Spain. ⁴ Respiratory Division, UZ-Leuven, Faculty of Kinesiology and Rehabilitation, KU-Leuven, Belgium.

CORRESPONDENCE: J. Roca, Servei de Pneumologia, Hospital Clínic, Villarroel 170, Barcelona-08036, Spain, Fax: 34 932275455. E-mail: jroca{at}clinic.ub.es

Keywords: Chronic obstructive pulmonary disease, healthcare delivery, information technology, integrated care, planned care

Received: May 31, 2005
Accepted March 25, 2006

Hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on the disease evolution and costs. The current authors postulated that a simple and well-standardised, low-intensity integrated care intervention can be effective to prevent such hospitalisations.

Therefore, 155 exacerbated COPD patients (17% females) were recruited after hospital discharge from centres in Barcelona (Spain) and Leuven (Belgium). They were randomly assigned to either integrated care (IC; n = 65; age mean±SD 70±9 yrs; forced expiratory volume in one second (FEV₁) 1.1±0.5 L, 43% predicted) or usual care (UC; n = 90; age 72±9 yrs; FEV₁ 1.1±0.05 L, 41% pred). The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team, as well as accessibility to a specialised nurse case manager through a web-based call centre.

After 12 months’ follow-up, IC showed a lower hospitalisation rate (1.5±2.6 versus 2.1±3.1) and a higher percentage of patients without re-admissions (49 versus 31%) than UC without differences in mortality (19 versus 16%, respectively).

In conclusion, this trial demonstrates that a standardised integrated care intervention, based on shared care arrangements among different levels of the system with support of information technologies, effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients.

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