Clinical research study
Effectiveness of Chronic Obstructive Pulmonary Disease-Management Programs: Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.amjmed.2008.02.009Get rights and content

Abstract

Background

Disease-management programs may enhance the quality of care provided to patients with chronic diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to assess the effectiveness of COPD disease-management programs.

Methods

We conducted a computerized search of MEDLINE, EMBASE, CINAHL, PsychINFO, and the Cochrane Library (CENTRAL) for studies evaluating interventions meeting our operational definition of disease management: patient education, 2 or more different intervention components, 2 or more health care professionals actively involved in patients' care, and intervention lasting 12 months or more. Programs conducted in hospital only and those targeting patients receiving palliative care were excluded. Two reviewers evaluated 12,749 titles and fully reviewed 139 articles; among these, data from 13 studies were included and extracted. Clinical outcomes considered were all-cause mortality, lung function, exercise capacity (walking distance), health-related quality of life, symptoms, COPD exacerbations, and health care use. A meta-analysis of exercise capacity and all-cause mortality was performed using random-effects models.

Results

The studies included were 9 randomized controlled trials, 1 controlled trial, and 3 uncontrolled before–after trials. Results indicate that the disease-management programs studied significantly improved exercise capacity (32.2 m, 95% confidence interval [CI], 4.1-60.3), decreased risk of hospitalization, and moderately improved health-related quality of life. All-cause mortality did not differ between groups (pooled odds ratio 0.84, 95% CI, 0.54-1.40).

Conclusion

COPD disease-management programs modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality. Future studies should explore the specific elements or characteristics of these programs that bring the greatest benefit.

Section snippets

Operational Definition of Disease Management

On the basis of several definitions,7, 10 we decided a priori that studies would meet our operational definition of disease management if their interventions included 2 or more different components (eg, physical exercise, self-management, structured follow-up), 2 or more health care professionals were actively involved in patient care, patient education was considered, and at least 1 component of the intervention lasted a minimum of 12 months. The latter criterion was set to avoid selecting

Results

The systematic search identified 12,749 titles that resulted in 1155 articles further screened by abstract, leading to 139 that were fully reviewed. Thirteen studies (15 articles) were retained (Figure 1)20, 28, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 and are described in Table 1 (available online). Nine were randomized controlled trials, 1 was a nonrandomized controlled trial, and 3 were uncontrolled before–after trials. The interventions varied in terms of their components and

Discussion

Our systematic review suggests that COPD disease-management programs improve exercise capacity, reduce the risk of hospitalization, and moderately improve health-related quality of life. Effects on lung function tests and symptoms were modest and probably not clinically relevant in isolation, and the point estimate of all-cause mortality tended to favor the intervention groups, but the CI remained too large to allow any definitive conclusion.

This review extends the work of other authors who

Conclusions

Our comprehensive systematic review of the literature suggests that disease-management programs for patients with COPD slightly improve exercise capacity and quality of life, and reduce hospitalization. Given the limits of classic pharmacotherapy alone at improving outcomes in COPD, the increase in walking distances and reduction of hospitalization induced by disease management are notable findings, and the nonsignificant lower all-cause mortality is a promising result. On the basis of our

Acknowledgments

The authors thank Anne Parrical and Anne Pittet, medical librarians at the University of Lausanne, and Drs Poole, Rea, Ries, and Soler-Cataluña, for providing further details on their studies.

References (48)

  • R.J. Halbert et al.

    Global burden of COPD: systematic review and meta-analysis

    Eur Respir J

    (2006)
  • B.R. Celli et al.

    Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

    Eur Respir J

    (2004)
  • P.K. Lindenauer et al.

    Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

    Ann Intern Med

    (2006)
  • D.P. Faxon et al.

    Improving quality of care through disease management: principles and recommendations from the American Heart Association's Expert Panel on Disease Management

    Circulation

    (2004)
  • A. Pilnick et al.

    Disease management: definitions, difficulties and future directions

    Bull World Health Organ

    (2001)
  • G. Ellrodt et al.

    Evidence-based disease management

    JAMA

    (1997)

  • DMAA definition of disease management

  • K. Kesteloot

    Disease managementA new technology in need of critical assessment

    Int J Technol Assess Health Care

    (1999)
  • J. Gonseth et al.

    The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports

    Eur Heart J

    (2004)
  • R. Roccaforte et al.

    Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patientsA meta-analysis

    Eur J Heart Fail

    (2005)
  • E. Badamgarav et al.

    Effectiveness of disease management programs in depression: a systematic review

    Am J Psychiatry

    (2003)
  • A. Neumeyer-Gromen et al.

    Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials

    Med Care

    (2004)
  • K. Knight et al.

    A systematic review of diabetes disease management programs

    Am J Manag Care

    (2005)
  • H. Rea et al.

    A chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary disease

    Intern Med J

    (2004)

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    Dr Isabelle Peytremann-Bridevaux is supported by a grant from the Bourse de la commission pour la promotion académique des femmes, faculté de biologie et médecine de l'université de Lausanne.

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