• Jean Bourbeau, Marcel Julien, François Maltais, Michel Rouleau, Alain Beaupré, Raymond Bégin, Paolo Renzi, Diane Nault, Elizabeth Borycki, Kevin Schwartzman, Ravinder Singh, Jean-Paul Collet, and Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Santé du Québec.
• Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, and Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada. jean.bourbeau@mcgill.ca
• Arch Intern Med. 2003 Mar 10;163(5):585-91.

BackgroundSelf-management interventions improve various outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease.MethodsA multicenter, randomized clinical trial was carried out in 7 hospitals from February 1998 to July 1999. All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year. Patients were assigned to a self-management program or to usual care. The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up. Over 12 months, data were collected regarding the primary outcome and number of hospitalizations; secondary outcomes included emergency visits and patient health status.ResultsHospital admissions for exacerbation of COPD were reduced by 39.8% in the intervention group compared with the usual care group (P =.01), and admissions for other health problems were reduced by 57.1% (P =.01). Emergency department visits were reduced by 41.0% (P =.02) and unscheduled physician visits by 58.9% (P =.003). Greater improvements in the impact subscale and total quality-of-life scores were observed in the intervention group at 4 months, although some of the benefits were maintained only for the impact score at 12 months.ConclusionsA continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status. This approach of care can be implemented within normal practice.

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