Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases

Objective. To investigate the effect of a primary care model for COPD on process of care and patient outcome. Design. Controlled study with delayed intervention in control group. Setting. The GP delegates tasks to a COPD support service ( CSS) and a practice nurse. The CSS offers logistic support to the practice through a patient register and recall system for annual history-taking and lung function measurement. It also forms the link with the chest physician for diagnostic and therapeutic advice. The practice nurse's most important tasks are education and counselling. Subjects. A total of 44 practices ( n = 22 for intervention and n = 22 for control group) and 260 of their patients >= 40 years with obstructive lung diseases. Results. Within the intervention group planned visits increased from 16% to 44% and from 19% to 25% in the control condition ( difference between groups p = 0.014). Annual lung function measurement rose from 17% to 67% in the intervention and from 11% to 18% in the control group ( difference between groups p = 0.001). Compared with control, more but not statistically significant smokers received periodic advice to quit smoking ( p = 0.16). At baseline 41% of the intervention group were using their inhalers correctly and this increased to 54% after two years; it decreased in the control group from 47 to 29% ( difference between groups p = 0.002). The percentage of patients without exacerbation did not change significantly compared with the control condition. The percentage of the intervention group not needing emergency medication rose from 79% to 84% but decreased in the controls from 81 to 76% ( difference between groups p = 0.08). Conclusion. Combining different disciplines in one model has a positive effect on compliance with recommendations for monitoring patients, and improves the care process and some patient outcomes.