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Effect of Adding Disease Management to COPD Care May Vary by Location

Allison Inserro
Payers have been rolling out disease management programs as a way to both control costs and improve outcomes for patients with chronic diseases, such as chronic obstructive pulmonary disease, asthma, diabetes, and others. But what happens to health outcomes when components of care considered COPD disease management in the United States are considered part of usual care elsewhere in the world?
“In contrast to most other studies, in our trial all patients received care recommended by the GOLD practice guidelines for patients with moderate–to–very severe COPD, ie, care delivered by consultant pulmonologists, and where relevant, by dietitians and social workers,” Kalter-Leibovici wrote. “In addition, all patients received recommended medical care (inhaled corticosteroids and long-acting bronchodilators) and supervised physical exercise sessions. All patients who were active smokers, regardless of study group assignment, were referred to smoking cessation group sessions and received prescription for smoking cessation medications.”
 
The DM piece of the study centered on giving advice in case of acute disease exacerbations; monitoring adherence to healthy lifestyle and drug therapy for COPD; coordination of care among all caregivers, including primary care providers; and provision of additional behavioral support for smoking cessation among active smokers, said Kalter-Leibovici.

She said that when she reviewed other DM studies, components of recommended care, such as pulmonary rehabilitation or smoking cessation, were provided as a part of the DM intervention, while the control group, or patients getting “usual care,” did not receive those interventions.

“In my opinion, these are flaws in the design of [some of] the trials, since these components are not traditionally included in the scope of disease management interventions,”  she said, adding later, “disease management interventions probably do not provide additional benefit to patients who already receive recommended care.”

References
1. Kalter-Leibovici O, Benderly M, Freedman LS, et al. Disease management plus recommended care versus recommended care alone for ambulatory patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018;197(12):1565-1574. doi: 10.1164/rccm.201711-2182OC.

2. Han MK, Martinez CH, Au DH, et al. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. The Lancet Respiratory Medicine. 2016;4(6):473-526. doi: 10.1016/S2213-2600(16)00094-1.

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