Self-management training is often included as part of an overall package to control a chronic illness. When this occurs, the program may be called a multidisciplinary, interdisciplinary, or integrated care intervention. A study in Spain examined an integrated treatment that included education, coordination among levels of care, and improved accessibility and reduced hospital readmissions in chronic obstructive pulmonary disease (COPD) after one year. Garcia-Aymerich and coworkers analyzed the effectiveness of this intervention in terms of clinical and functional status, quality of life, lifestyle, and self-management. Their hypothesis was that changes in these factors could explain the observed reduction in readmissions. The 113 COPD patients were recruited after hospital discharge in Barcelona, Spain, and randomly assigned to integrated care or usual care. The intervention consisted of an individually tailored care plan at discharge shared with the primary care team and access to a specialized case manager nurse through a web-based call center. One year after intervention, subjects in the intervention group improved body mass and scored better in self-management items, including COPD knowledge, exacerbation identification, early treatment of exacerbations, inhaler adherence, and correct use of the inhaler. No differences in breathlessness, lung function, quality of life scores, lifestyle factors, or medical treatment occurred.

COMMENTS: The authors concluded that the study showed improved disease knowledge, and treatment adherence after one year of intervention, suggesting that these factors may play a role in the prevention of severe COPD exacerbations that triggered hospital admissions. This may be the case. One might hope that changes in breathlessness and lung function to also occur, but this rarely happens in studies of COPD. Nevertheless, at this stage, any programs for teaching self-management skills to COPD patients is welcomed.

J. Garcia-Aymerich et al. Effects of an integrated care intervention on risk factors of COPD readmission. Respiratory Medicine, 2007;101:1462-1469.