A COPD Health Management Program in a Community-Based Primary Care Setting: A Randomized Controlled Trial

作者：Peian Lou, Peipei Chen, Pan Zhang, Jiaxi Yu, Yong Wang, Na Chen, Li Zhang, Hongmin Wu, Jing Zhao · 发表于：Respiratory Care · 年份：2014 · DOI：10.4187/respcare.03420 · 被引用次数：53 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Diabetes Management and Education、Primary Care and Health Outcomes

BACKGROUND: A number of effective strategies have been developed to improve the quality of life in patients with COPD. However, few have been implemented in patients with COPD at all stages in a community setting. This study evaluated the efficacy of a complex COPD health management intervention in rural communities in China. METHODS: A randomized controlled trial including 8,217 subjects with COPD was implemented from May 2008 to May 2012 in 14 community health-care centers. The control group of subjects received usual care, whereas the management group of subjects participated in a health management program that included assessing the subjects' health status, giving regular health lectures, smoking cessation counseling, encouraging regular exercise, providing rehabilitative training and psychological counseling, and regular follow-up. As a primary outcome, we examined the changes in the BODE index. Secondary outcomes included depression and anxiety rates, current smoking rate, awareness of COPD, mortality, risk factors, respiratory medication use, hospital admissions, and emergency department visits. RESULTS: After 4 y, the mean cumulative value of the BODE index increased by 0.7 per subject in the control group and decreased by 0.4 per subject in the health management group (difference of 1.1, 95% CI 0.2-2.0, P < .001). Health management reduced anxiety symptoms by 4.8%, depression symptoms by 6.6%, current smoking by 14.3%, mortality due to all causes by 9.0%, hospitaliza...