Some recent and ongoing work around DM for COPD

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Some recent and ongoing work around DM for COPD

• Dr Stephanie Taylor
• s.j.c.taylor_at_qmul.ac.uk
• DM in the European context, Bonn, January 2007

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Structure of this presentation, 2 areas.

• Evidence around UK disease management models
  particularly with regard to COPD
• Qualitative studies of patient experiences of
  Early Supported Discharge Schemes (EDS)

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Living with longstanding conditions 2005
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Case management

• 3000 Community Matrons to be in post by March
  2007
• Kings Fund suggest little evidence to support
  reduction in admissions (patients may feel
  better)
• Add bit re national eval inBMJ
• Anecdotally may be hard to recruit
  re-badging of some community nurses

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Living with longstanding conditions 2005
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Care ManagementExtended systematic review

• Aims of extended systematic review
• To review the relevant published quantitative
  and qualitative studies and grey literature
  concerning innovations involving nurses for
  people with COPD in the community. Specific
  questions included
• What is the evidence to support the effectiveness
  of the different interventions?
• (Taylor, BMJ, 2005)

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Extended systematic review Methods

• English (and Dutch) language studies
• All methodologies
• Searched 19 electronic databases, including usual
  suspects
• Jan 1980 March 2003
• Identified over 6,400 unique references

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Results I

• 9 RCTs describing care management/ case
  management
• Quality most had potential methodological
  limitations
• 5 studies no sample size calculation or failed
  to achieve intended sample size
• Variety of endpoints reported meta-analysis of
  all outcomes not possible

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Results II Nature of interventions

• Two brief interventions (around 1/12), remainder
  long term or intensive
• Telephone follow up (3 studies)
• Educational packages
• Home visits
• Only two most recent studies
• Self management plans
• Drugs/ prescription at home for acute
  exacerbation

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Results III

• Mortality at 9-12 months
• Peto odds ratio
• 0.85 favouring intervention,
• (95 confidence interval 0.58, 1.26)
• All cause readmission to hospital
• Results equivocal

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Results IV HRQOL

• Meta-analysis of 3 studies reporting HRQOL
  measured by St Georges respiratory questionnaire
  score at 3-6 months follow-up no detectable
  effect.
• Overall no evidence that long term interventions
  improve patients HRQOL at 12 months follow-up.

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Living with longstanding conditions 2005
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Supported Self Care UK Expert Patient Programmes

• Six weekly 2.5 hour sessions
• Led by an accredited lay facilitator
• Content
• Problem solving
• Exercise and relaxation
• Diet
• Positive thinking
• Lay facilitator models good coping
• Based on Banduras self-efficacy theory

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Systematic Review of Expert Patient Programmes

• Preliminary results of this Cochrane Review
  reported at meeting

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Early Supported Discharge Two qualitative
studies.

• Schofield 2006 (Int J Nurs Stud)
• Postal survey in depth interviews with ARAS
  users and carers
• Aimed to measure satisfaction and future
  preferences for site of care
• Interviews
• home care preferred
• overwhelming endorsement for ARAS

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Two qualitative studies

• Clarke 2006 (in preparation)
• in depth interviews with people who had accepted
  and declined early supported discharge in and
  inner London setting
• Aimed to look at patient experience of care
• Preliminary results reported

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Acknowledgements

• Extended review Survey Ms Bridget Candy, Dr
  Jean Ramsey, Prof Ros Bryar, Prof Chris
  Griffiths, Mr Brian Schrin, Ms Glenda Esmond, Dr
  Bert Virjoef, ProfJadwiga Wedzicha, Ms Gill
  Foster, Ms Glenda Esmond, Ms Jill Goddard, Ms
  Hazel Kilvington, Prof Gene Feder, Prof Martin
  Underwood, Ms Annette Boaz, RCN, ARMS, BLF,
  Breathe Easy Groups National COPD Audit Prof M
  Roberts Newham Evaluation Dr Aileen Clarke, Ms
  Ratana Sohanpal, Dr Yu Mei Chang, Dr Graeme
  Wilson