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'The COPD breathlessness manual': a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease.

Howard C, Dupont S - NPJ Prim Care Respir Med (2014)

Bottom Line: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group.At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group.Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture.

Aims: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status.

Methods: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups.

Results: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05-3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.

Conclusion: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.

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Related in: MedlinePlus

Estimated marginal means of depression over time.
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fig4: Estimated marginal means of depression over time.

Mentions: At 6 months, 7% in the CM group remained clinically depressed, compared with 15% in the IB group. Greenhouse–Geisser estimates showed a significant main effect of depression and time (F (1.8,176.0)=14.179, P⩽0.001) and a significant interaction between depression and group (F (1.8,176.0)=10.697, P⩽0.001) (see Figure 4). The contrast between group and depression at baseline versus 6 months was significant (F (1,99)=10.341, P=0.002, r=0.3) with lower depression levels in the CM group, but not at 6 weeks versus 6 months (F (1,99)=0.378, P=0.540, r=0.1).


'The COPD breathlessness manual': a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease.

Howard C, Dupont S - NPJ Prim Care Respir Med (2014)

Estimated marginal means of depression over time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373470&req=5

fig4: Estimated marginal means of depression over time.
Mentions: At 6 months, 7% in the CM group remained clinically depressed, compared with 15% in the IB group. Greenhouse–Geisser estimates showed a significant main effect of depression and time (F (1.8,176.0)=14.179, P⩽0.001) and a significant interaction between depression and group (F (1.8,176.0)=10.697, P⩽0.001) (see Figure 4). The contrast between group and depression at baseline versus 6 months was significant (F (1,99)=10.341, P=0.002, r=0.3) with lower depression levels in the CM group, but not at 6 weeks versus 6 months (F (1,99)=0.378, P=0.540, r=0.1).

Bottom Line: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group.At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group.Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Health Psychology, Central and North West London NHS Foundation Trust, The Hillingdon Hospital, Pield Heath Road, Uxbridge, UK.

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a costly long-term condition associated with frequent Accident and Emergency (A&E) and hospital admissions. Psychological difficulties and inadequate self-management can amplify this picture.

Aims: To compare a cognitive-behavioural manual versus information booklets (IB) on health service use, mood and health status.

Methods: Two hundred and twenty-two COPD patients were randomly allocated to receive either the COPD breathlessness manual (CM) or IB. They were instructed to work through their programme at home, over 5 weeks. Guidance from a facilitator was provided at an initial home visit plus two telephone call follow-ups.

Results: After 12 months, total A&E visits had reduced by 42% in the CM group, compared with a 16% rise in the IB group. The odds of people in the IB group attending A&E 12 months post-intervention was 1.9 times higher than for the CM group (CI 1.05-3.53). Reduction in hospital admissions and bed days were greatest in the CM group. At 6 months, there were significantly greater improvements in anxiety (F (2,198)=5.612, P=0.004), depression (F (1.8,176.1)=10.697, P⩽0.001) and dyspnoea (F (2,198)=18.170, P⩽0.001) in the CM group. Estimated savings at 12 months were greatest in the CM group, amounting to £30k or £270 per participant.

Conclusion: The COPD manual, which addresses physical and mental health, is a straightforward cost-effective intervention that is worth offering to COPD patients within primary or secondary care.

Show MeSH
Related in: MedlinePlus