A cluster randomised controlled trial of nurse and general practitioner partnership for care of COPD
Project Short Title
Nicholas Zwar, Oshana Hermiz
Sandy Middleton, Guy Marks, Elizabeth Comino
Other Team Members
In Australia COPD is the third leading cause of disease burden after ischaemic heart disease and stroke. Its prevalence is estimated at 3.5% of the Australian population. National guidelines for detection and management of COPD are now available. Key recommendations from the COPD guidelines for preventing or slowing disease progression and optimising function for COPD patients are: Smoking cessation, pulmonary rehabilitation, Influenza vaccination, optimising use of inhaled bronchodilators, optimising use of inhaled corticosteroids, and patient education.
General practice is well placed to provide early intervention and management of COPD patients. There is evidence that involving a nurse in patients care improves patient self care, quality of life, and satisfaction. There is also evidence that GPs implementing a care plan with advice from a respiratory nurse and specialist physician reduced hospital admissions and reduced hospital bed days, and significant improvements in spirometry and two dimensions of the Chronic Respiratory Questionnaire (fatigue and mastery).
The research aims to determine the impact of this partnership on the quality of care and health outcomes for patients with COPD at six and 12 months follow-up.
The hypotheses to be tested are:
- The intervention improves disease-related quality of life and overall health of patients with COPD measured by patient health status, lung function and health service use
- The intervention improves the quality of care provided to patients with COPD with impacts on knowledge, immunisation compliance, smoking cessation and satisfaction with care.
This is a cluster randomised clinical trial. GPs practicing within the 4 Divisions of GP of South West Sydney have been invited to participate. Partcipating GPs(50) have identified their patients with COPD by searching their medical software using medications commonly used to treat COPD as a search criteria. Consenting patients have had provided baseline data including demographic data, history of the COPD, smoking and immunisation history, comorbidities and medication used, lung function test using spirometry, health service use, general health using SF12 and disease specific quality of life using St George Respiratory Questionnaire. Practitioner have been randomised to intervention and control group and the CIPD nurse intervention is in progress . When baseline data collection is completed, consenting GPs will be randomised by a UNSW member staff not linked to this study to intervention and control groups in blocks of 4. Patients of GPs in the intervention group will receive the 6 month intervention while patient of GPs in the control group will receive the usual GP care. Data will be collected at 2 other points in time, at the completion of the intervention (6 months from baseline) and 6 months later (12 months from the baseline).
Zwar N, Hermiz O, Hasan I, Comino C, Middleton S, Vagholkar S, Marks G. A cluster randomised controlled trial of nurse and GP partnership for care of Chronic Obstructive Pulmonary Disease. BMC Pulmonary Medicine 2008, 8:8 (in press)