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SYSTEMATIC REVIEW OF DISEASE MANAGEMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

University of Texas Health Science Center at San Antonio and The South Texas Vet, San Antonio, TX

PURPOSE: The chronic illness care model (CICM) has been shown to improve outcomes in diabetes mellitus and congestive heart failure, but data regarding the effectiveness of a comprehensive model in patients with chronic obstructive pulmonary disease (COPD) are lacking. A systematic review of the literature was undertaken to determine the effectiveness of the components of the CICM in patients with COPD.

METHODS: MEDLINE, CINAHL, and COCHRANE databases were searched from the earliest date available to January of 2005 to identify English-language articles that evaluated outcomes of adults with an intervention of at least one of the components of the CICM in patients with COPD.

RESULTS: A total of 514 abstracts were screened, but only 32 articles were suitable for full abstraction and review. These studies were heterogeneous (different interventions and outcomes) and only a few met standard criteria for high quality. Outcomes such as symptoms, quality of life, lung function, and functional status were not significantly different between the intervention and control groups. However, the pooled relative risk (RR) and 95% confidence intervals (CI) for the emergency/unscheduled visits for the group who received at least 2 components of the CICM was 0.575 (0.418, 0.790) and for the length of hospital stay was -0.522 (-0.721, -0.322). There was no significant change in healthcare utilization in the control groups or in patients who received only one component (such as self-management alone) of the CICM.

CONCLUSION: Only limited data are available in the literature evaluating interventions of any of the components of the CICM in patients with COPD. However, the pooled data from the available studies demonstrated that patients with COPD who received interventions including 2 or more components of the CICM had lower rates of emergency/unscheduled visits and an overall shorter length of hospital stay than patients who received only one component or those who were in the control groups.

CLINICAL IMPLICATIONS: Implementation of multiple components of the CICM in patients with COPD has the potential to significantly reduce healthcare utilization.

DISCLOSURE: Sandra Adams, None.