Prof. Dr. Daniel Kotz 24 March 2017
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1 Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care Prof. Dr. Daniel Kotz 24 March 2017 Heinrich-Heine-University Düsseldorf, Institute of General Practice, Centre for Addiction Research and Clinical Epidemiology Maastricht University University College London University of Edinburgh
2 DEBRA symposium 30 June 2017 Theme: tobacco smoking and e-cigarette use in Germany: findings from a new national survey (DEBRA) in an international perspective. Düsseldorf, 30 June 2017, h Keynote lecture: Prof. Robert West, University College London Free registration:
3 Disclosures Funding sources for presented work Lung Alliance Netherlands ( Industry funding to the investigator in the last 5 years None
4 COPD COPD affects millions of people worldwide, having major impact on daily life COPD is more than airway limitation (FEV 1 ) burden of COPD as experienced by the patient how to measure this burden and treat accordingly ("control panel" for physicians)? [Agusti, Thorax 2013; GOLD 2017]
5 Assessment of Burden of COPD (ABC) tool quantification and visualisation of the burden of COPD, thereby facilitating the integrated approach crucial for assessment and individualised treatment of COPD
6 ABC tool: development 1. definition of burden Burden of disease is the physical, emotional, psychological and/or social experiences of a patient with COPD. These experiences influence the patient's ability to cope with the consequences of COPD and its treatment. 2. face validity check (patients, healthcare providers) [Slok, Npj Primary Care Resp Med 2014]
7 ABC tool: development 3. condition a burden of COPD tool should meet 4. literature review > Clinical COPD Questionnaire (CCQ) comes close [Van der Molen, Health Qual Life Outcomes 2003] [Slok, Npj Primary Care Resp Med 2014]
8 ABC tool: development 5. development ABC scale = CCQ - symptoms - functional state - mental state + 3 items to measure emotions + 1 item to measure fatigue [Slok, Npj Primary Care Resp Med 2014]
9
10 ABC tool: development 6. development ABC tool = ABC scale + objective parameters - smoking - exacerbations - dyspnoea (MRC) - body mass index - lung function - physical activity > computer algorithm > visualisation (treatment advice) [Slok, Npj Primary Care Resp Med 2014]
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12 ABC tool: rationale ABC tool = basis for shared decision making to support personalised care planning, including a personal treatment goal treatment goals often include lifestyle changes ABC tool = communication tool in primary and hospital care
13 Aim current study Assess effectiveness in pragmatic study: P I C O patients with COPD use of ABC tool care as usual disease-specific quality of life based St. George s Resp. Questionnaire (SGRQ) over 18 months
14 Netherlands Trial Register, NTR3788
15 Trial design pragmatic, two-armed, cluster randomised controlled trial 56 healthcare centres across the Netherlands 39 primary care 17 hospital care March 2013 to May 2015
16 Patient in/exclusion criteria spirometry-confirmed diagnosis 40 years of age or over understand and read the Dutch language exacerbation <6 weeks before study addiction to hard drugs life-threatening comorbid condition or pregnancy
17 Intervention vs. control Intervention: instruction healthcare providers to use ABC tool during routine consultations (min. every 6 months) Control: care as usual (Dutch COPD healthcare guidelines)
18 Outcomes Primary: clinically relevant improvement on the SGRQ = decrease of at least 4 points on the total score of the SGRQ between baseline and the 18- month follow-up Secondary: (amongst others) COPD Assessment Test (CAT) Patient Assessment of Chronic Illness Care (PACIC)
19
20 Slok, BMJ Open 2016
21 Slok, BMJ Open 2016
22 Slok, BMJ Open 2016
23 Secondary outcomes CAT not significant difference: 0.26 points (95%CI: 1.52 to 0.99) PACIC higher improvement in intervention group: 0.32 points (95%CI: 0.14 to 0.50)
24 Discussion ABC tool seems to have added value for patients with COPD patients treated with ABC tool were more likely to report clinically relevant improvement in their quality of life in the Netherlands: nationwide implementation in daily care ongoing
25 Discussion ABC tool for Germany? Opportunities: improved patient care? Threats: lack of time? lack of communication skills?
26 Download today's presentation at
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