Supported self-management of COPD does not decrease readmission or mortality rates
by Alexander R. Carbo, MD, SFHM, Jonathan T. Crocker, MD, Lauren Doctoroff, MD, FHM, Elizabeth Farrell, MD, Rebecca Newlin Hutchinson, MD, MPH, Hospital Medicine Program, Beth Israel Deaconess Medical Center, Boston
Clinical question: Does supported self-management of patients with chronic obstructive pulmonary disease (COPD) decrease COPD-related hospital readmission or death?
Clinical background: Supported self-management has benefited patients with such chronic diseases as heart failure and asthma. Evidence to support such a strategy for patients with COPD is relatively lacking.
Study design: Randomized, controlled trial.
Setting: Community-based care following urban hospitalization in western Scotland.
Synopsis: From June 2007 to May 2009, and following hospitalization for COPD exacerbation, 464 patients were randomized to receive routine community-based care with or without 12 months of support and training to detect, and promptly treat, recurrent exacerbations. Independent of disease severity or demographics, investigators found no difference in combined readmission rates (48% vs. 47%, 95% confidence interval [CI] 0.80-1.38) or death (10% vs. 7%, 95% CI 0.71-2.61).
Based on review of appropriateness of self-management strategies used by the intervention group, unplanned exploratory subgroup analysis classified a minority of the intervention group as “successful” (42%) supported self-managers, and demonstrated decreased COPD readmissions and deaths (27% vs. 49%, 95% CI 0.25-0.76, P=0.003) vs. “unsuccessful” self-managers. This successful group was younger and tended to live with others. Further research to define characteristics of patients who benefit from self-management is needed.
Bottom line: Supported self-management of COPD does not reduce COPD-related readmissions or deaths in a large population.
Citation: Bucknall CE, Miller G, Lloyd SM, et al. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ. 2012;344:e1060.
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