Primary care Early Intervention for COPD Management

Project Short Title

Project Status

Project Coordinator
Nick Zwar, Sarah Dennis

Chief Investigators
Nick Zwar, Sandy Middleton, Helen Reddel,Onno van Schayck, Alan Crocket, Sarah Dennis

Associate Investigators
Sanjyot Vagholkar, Oshana Hermiz and Iqbal Hasan


This cluster randomised trial will test new approaches to the management of COPD in primary care. The aim is to assess the effectiveness of early intervention by a GP-practice nurse partnership applying evidence based guidelines to assess and manage patients newly identified as having COPD. The effectiveness of this intervention will be assessed by examining quality of care and health outcomes at six and 12 months follow-up.

The hypothesis being tested is that early intervention by a practice nurse-GP partnership will improve outcomes (disease related quality of life, smoking cessation rates; immunisation; disease knowledge; medication use and inhaler technique) for patients with COPD, compared with usual care. Subsidiary aims also include validation of the CAT and the CDQ (both of which have yet to be validated in Australia)

Design and Method

This cluster randomised controlled trial will test the hypothesis that early intervention by a practice nurse-GP partnership will improve outcomes for patients newly diagnosed with COPD, compared with usual care. Since the intervention involves a team approach by treating practitioners randomisation will occur at the practice level rather than at the level of individual patients (CONSORT guidelines29).

Practices will be randomised (by the independent statistician) to either apply a practice nurse-GP team management approach, or usual care, to these newly diagnosed patients. Randomisation will occur after practitioner recruitment and before patient recruitment. Practices will be stratified before randomisation on the basis of practice size, SEIFA classification and participation or not in previous COPD activities such as Collaboratives. All participating practices will use case finding methods to identify a cohort of patients with newly diagnosed COPD.

The comparators between the groups resulting from the two different management approaches at the six months and twelve months follow-up points will be disease-specific quality of life (primary outcome measure - SGRQ) The CAT will also be used as a disease specific QOL measure; smoking cessation rates; immunisation; medication and particularly inhaler prescription and effective inhaler use; referral for pulmonary rehabilitation and also referral for or provision of exercise prescriptions; disease related knowledge; patient satisfaction; health care utilisation and lung function.

Key Publications

Jeremy Bunker, Oshana Hermiz, Nicholas Zwar, Sarah M Dennis, Sanjyot Vagholkar, Alan Crockett, et al. Feasibility and efficacy of COPD case finding by practice nurses. Australian Family Physician. 2009;38(10):826-30.