Interdisciplinary model of care for COPD in Australian primary care

Introduction: Gaps exist between recommended guidelines and primary care management of COPD. The evidence for interdisciplinary, integrated disease management programs in COPD is still uncertain.
Aim: To evaluate the effectiveness of an interdisciplinary, primary care-based model of care on health-related quality of life, symptom severity, smoking cessation and lung function in patients with COPD.
Methods: A cluster randomised controlled trial (Review of Airways Dysfunction and Interdisciplinary Community-based care of Adult Longterm Smokers – RADICALS) was conducted across 43 general practice clinics in Melbourne, Australia. The model of care delivered in the intervention arm comprised smoking cessation support, home medicines review (HMR), and home-based pulmonary rehabilitation (HomeBase). Main outcomes measured at six and 12 months included changes in St George’s Respiratory Questionnaire (SGRQ) score, COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnoea scale, smoking abstinence and lung function.
Results: A total of 272 participants with COPD were identified (157 intervention, 115 usual care). One-third of the intervention patients (50/157, 32%) completed both HMR and HomeBase. Intention-to-treat analysis showed no statistically significant difference in change in SGRQ score at six months (adjusted between group difference 2.45 favouring intervention, 95%CI –0.89 to 5.79). Per protocol analyses showed clinically and statistically significant improvements in SGRQ at six months in those receiving the full intervention compared to usual care (difference 5.41, 0.53 to 10.3). No significant differences were observed for change in CAT, mMRC, smoking abstinence or lung function.
Conclusion: No significant evidence was found for the effectiveness of an interdisciplinary model of care for COPD over usual care in primary care. Low intervention uptake from general practitioners and patients was a challenge. This model could potentially be more effective with strategies to improve adherence and intervention fidelity. A larger, well-powered trial in patients with more severe disease is warranted.