Health outcomes for patients with severe COPD improve with integrated primary care

Integrated primary care services can offer better outcomes for patients living with severe chronic obstructive pulmonary disease (COPD) without increasing costs.

A prospective cohort study published in European Journal of General Practice suggests that integrated primary care can help improve the health status of patients with severe chronic obstructive pulmonary disease (COPD) without increasing healthcare costs.

The integrated primary care intervention considered in the study provides input from pulmonologists, based on published guidelines and patient medical history and questionnaire responses, to assist general practitioners (GPs) in the diagnosis and management of COPD.

The patients participating in this study were recruited through their general practitioners located in the northern regions of the Netherlands. They had to be at least 40 years old and meet the 2014 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for severe COPD classified as GOLD-D.

At the participating GPs, all patients with known or suspected COPD were seen by the Asthma/COPD Service (AS), which provided integrated primary care. In other practices, only patients who consulted their general practitioners for pulmonary complaints or had a previous diagnosis of COPD were referred for assessment.

A total of 217 eligible patients were referred to the AC service. Many were not included in the study, mainly because the time between referral and contact with the GP or patient was too long, leaving 49 patients included in the analysis.

The primary outcome of the study was to assess health status, which was obtained using the COPD Clinical Questionnaire (CCQ) and the COPD Assessment Test (CAT). Secondary study outcomes were self-reported exacerbations, quality-adjusted life-years, and healthcare-related costs.

At 12 months, the study found that mean CAT score (15.9 at baseline) and mean CCG score (1.7 at baseline) improved by 2.3 (95% CI, 0.8-3.7) and 0.4 (95% CI, 0.2-0.7), respectively.

“Patients experienced significant improvements in COPD-related health status and a dramatic reduction in exacerbation rates,” the authors wrote. “Specifically, these changes occurred between baseline and the 6-month follow-up, after which health status and exacerbation rates remained more or less stable.” Average utilities based on overall health-related quality of life measures show the same trend over time.

The percentage of patients with at least 2 exacerbations in the past year also improved from 77.6% at baseline to 16.7% at month 12.

According to the study authors, more research needs to be done as this study has limitations. For example, the study was conducted using observational data without a comparison group.

Therefore, the researchers wrote, “more robust evidence from randomized controlled trials comparing integrated care with usual care is needed before firm conclusions can be drawn about the effectiveness of integrated care.”

Furthermore, the small group of 49 patients may have been in better health than would be expected for the average GOLD group D patient in primary care.

Still, the authors highlight the promising results seen in their study, as well as the fact that health care costs did not increase after receiving integrated care services.

“Based on the findings of our observational 1-year follow-up study, we conclude that an integrated primary care-based service for patients with COPD can improve the health status of patients with a high disease burden, while not increasing costs healthcare. Randomized controlled and adequately powered trials compared with usual care are needed to substantiate our results,” the researchers concluded.


de Jong C, van Boven JFM, de Boer MR, Kocks JWH, Berger MY, van der Molen T. Improved health status of patients with severe COPD after inclusion in an integrated primary care service: a prospective cohort study. Eur J Gen Pract. 2022; 28 (1): 66-74. doi:10.1080/13814788.2022.2059070

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