Background
Methods
Study design
Setting
Intervention
Randomisation and sample size
Randomisation and allocation concealment
Intervention | Control | Ext. control | Total | |
---|---|---|---|---|
N (%)
| 21 (33.3) | 17 (27.0) | 25 (39.7) | 63 (100) |
Male (%)
| 14 (66.7) | 13 (76.5) | 13 (52.0) | 40 (63.5) |
Mean age in years (min-max)*
| 51.6 (36–62) | 49.2 (37–65) | 51.6 (32–63) | 50.9 (32–65) |
Mean number of patients per GP (SD) *
| 1579 (210) | 1290 (457) | 1108 (295) | 1296 (386) |
No COPD CME
**
Attendance (%)
| 4 (21.1) | 5 (38.5) | # | # |
Did not routinely perform spirometry for smokers with symptoms (%)
| 10 (50.0) | 4 (30.8) | # | # |
Did not routinely stratify patients with COPD (%)
| 9 (45.0) | 6 (46.2) | # | # |
Did not routinely note the MRC score in the patient file (%)
| 15 (75.0) | 10 (76.1) | # | # |
Did not routinely provide prescription for antibiotics (%)
| 18 (90.0) | 11 (84.6) | # | # |
Sample size
The COPD algorithm
Participants
Data
Register data
Questionnaire data
Analyses
Ethics
Results
Patients
Patients identified by COPD algorithm | ||||
---|---|---|---|---|
Intervention | Control | Ext. control | Total | |
N (%)
| 877 (32.1) | 766 (28.0) | 1,092 (39.9) | 2,735 (100) |
Men (%)
| 399 (45.5) | 354 (46.2) | 492 (45.0) | 1,244 (45.5) |
Female (%)
| 478 (54.5) | 412 (53.8) | 600 (55.0) | 1,491 (54.5) |
Mean age (min-max)
| 63.9 (35–97) | 63.3 (35–96) | 63.3 (35–101) | 63.5 (35–101) |
CD Population
| ||||
Patients identified by algorithm who confirmed that they had COPD
| ||||
Intervention
|
Control
|
Ext. control
|
Total
| |
n (%)
| 458 (33.4) | 376 (27.4) | 538 (39.2) | 1,372 (100) |
Proportion of N (%)
| 52.2 | 49.1 | 49.3 | 50.2 |
Mean age (min-max)
| 222 (48.5) | 179 (47.6) | 264 (49.1) | 665 (48.5) |
Men (%)
| 236 (51.5) | 197 (52.4) | 274 (50.9) | 707(51.5) |
Female (%)
| 67.6 (36–91) | 66.3 (35–91) | 66.7 (36–94) | 66.9 (35–94) |
Primary outcome
N= 1372 | Intervention (N=458) | Control (N=376) | Ext. control (N=538) | Intervention vs. Control RR | Intervention vs. Ext control RR | Control vs. Ext control RR | |
---|---|---|---|---|---|---|---|
Number of patients who had a planned preventive
| 2008-09 |
0.34 0.27;0.44 |
0.24 0.17;0.33 |
0.25 0.14;0.45 |
1.43 0.96;2.13 |
1.35 0.72;2.52 |
0.95 0.49;1.81 |
consultation
| 2009-10 |
0.53 0.42;0.68 |
0.21 0.15;0.30 |
0.29 0.17;0.48 |
2.52
1
1.62;3.92 |
1.84
1
1.05;3.24 |
0.73 0.39;1.36 |
RR
|
1.55
2
1.23;1.96 |
0.88 0.69;1.12 |
1.14 0.91;1.42 |
1.77
2
1.26;2.48 |
1.36 0.98;1.88 |
0.77 0.55;1.07 | |
Number of patients who had an additional
| 2008-09 |
0.11 0.05;0.27 |
0.06 0.03;0.14 |
0.10 0.06;0.18 |
1.86 0.56;6.17 |
1.09 0.39;3.07 |
0.59 0.22;1.55 |
preventive consultation
| 2009-10 |
0.23 0.11;0.48 |
0.08 0.03;0.21 |
0.12 0.07;0.24 |
3.00 0.87;10.35 |
1.86 0.70;4.91 |
0.62 0.19;2.03 |
RR
|
2.03
2
1.26;3.27 |
1.26 0.84;1.89 |
1.19 0.84;1.71 |
1.61 0.86;3.01 |
1.70 0.94;3.09 |
1.05 0.62;1.81 | |
Number of patients who had a spirometry
| 2008-09 |
0.33 0.26;0.41 |
0.23 0.16;0.33 |
0.22 0.17;0.28 |
1.43 0.92;2.23 |
1.48
1
1.05;2.08 |
1.03 0.66;1.63 |
performed at the GP practice
| 2009-10 |
0.45 0.34;0.58 |
0.24 0.16;0.36 |
0.22 0.15;0.34 |
1.82
1
1.23;2.94 |
2.01
1
1.23;3.01 |
1.10 0.62;1.96 |
RR
|
1.36
1
1.09;1.70 |
1.07 0.85;1.34 |
1.00 0.70;1.44 |
1.27 0.93;1.75 |
1.36 0.89;2.08 |
1.07 0.70;1.64 | |
Number of patients who were admitted to hospital
| 2008-09 |
0.24 0.20;0.29 |
0.21 0.17;0.26 |
0.24 0.21;0.28 |
1.16 0.86;1.55 |
1.01 0.80;1.29 |
0.88 0.67;1.15 |
without a lung-related diagnosis
| 2009-10 |
0.22 0.18;0.26 |
0.26 0.23;0.30 |
0.26 0.21;0.31 |
0.82 0.66;1.02 |
0.83 0.64;1.07 |
1.01 0.81;1.26 |
RR
|
0.88 0.74;1.05 |
1.24 0.99;1.56 |
1.08 0.92;1.26 |
0.71
2
0.53;0.94 |
0.82 0.65;1.03 |
1.15 0.87;1.52 |
N= 1372 | Intervention (N=458) | Control (N=376) | Ext. control (N=538) | Intervention vs. Control IRR | Intervention vs. Ext control IRR | Control vs. Ext control IRR | |
---|---|---|---|---|---|---|---|
Consultations with GP (daytime)
| 2008-09 |
7.75 6.76-8.87 |
7.57 6.43-8.92 |
6.75 6.24-7.29 |
1.02 0.83-1.26 |
1.15 0.98-1.34 |
1.12 0.94-1.34 |
2009-10 |
7.34 6.60-8.17 |
8.50 7.12-10.14 |
7.28 6.73-7.88 |
0.86 0.71-1.06 |
1.01 0.88-1.15 |
1.17 0.96-1.41 | |
IRR
|
0.95 0.88-1.02 |
1.12
2
1.08-1.17 |
1.08
2
1.02-1.44 |
0.85
2
0.78-0.92 |
0.88
1
0.80-0.96 |
1.04 0.97-1.12 | |
Contacts to out-of-hours services
| 2008-09 |
0.68 0.47-0.98 |
0.60 0.42-0.86 |
0.61 0.51-0.74 |
1.12 0.66-1.90 |
1.10 0.73-1.66 |
0.99 0.66-1.47 |
2009-10 |
0.69 0.47-1.01 |
0.74 0.56-0.98 |
0.56 0.46-0.68 |
0.93 0.60-1.45 |
1.23 0.83-1.83 |
1.32 0.94-1.85 | |
IRR
|
1.02 0.85-1.22 |
1.22
1
1.02-1.48 |
0.92 0.78-1.08 |
0.83 0.64-1.08 |
1.12 0.88-1.42 |
1.34
1
1.05-1.71 | |
Admissions with another diagnosis
| 2008-09 |
0.35 0.27-0.45 |
0.36 0.28-0.46 |
0.33 0.28-0.38 |
0.97 0.68-1.38 |
1.06 0.79-1.43 |
1.10 0.82-1.46 |
2009-10 |
0.33 0.27-0.41 |
0.47 0.38-0.58 |
0.45 0.36-0.56 |
0.70
1
0.52-0.94 |
0.74 0.55-1.01 |
1.06 0.78-1.43 | |
IRR
|
0.95 0.69-1.32 |
1.31 0.91-1.88 |
1.36
1
1.06-1.74 |
0.73 0.44-1.18 |
0.70 0.47-1.05 |
0.96 0.62-1.49 | |
Bed days
| 2008-09 |
1.56 1.09-2.22 |
2.07 1.55-2.63 |
1.48 1.11-1.98 |
0.77 0.49-1.21 |
1.05 0.67-1.63 |
1.36 0.90-2.06 |
2009-10 |
1.61 1.33-1.96 |
1.70 1.26-2.29 |
2.01 1.59-2.56 |
0.95 0.66-1.36 |
0.80 0.60-1.07 |
0.84 0.58-1.23 | |
IRR
|
1.04 0.69-1.56 |
0.84 0.64-1.11 |
1.36
1
1.09-1.70 |
1.23 0.75-2.02 |
0.76 0.48-1.21 |
0.62
1
0.43-0.89 | |
Readmissions^
| 2008-09 |
0.07 0.05-0.12 |
0.13 0.10-0.17 |
0.05 0.04-0.08 |
0.56
1
0.33-0.97 |
1.38 0.78-2.47 |
2.45
2
1.53-3.94 |
2009-10 |
0.07 0.05-0.09 |
0.12 0.06-0.21 |
0.14 0.11-0.19 |
0.59 0.30-1.15 |
0.48
1
0.32-0.72 |
0.82 0.42-1.60 | |
IRR
|
0.95 0.55-1.63 |
0.90 0.50-1.64 |
2.71
2
1.90-3.86 |
1.05 0.46-2.38 |
0.35
2
0.18-0.66 |
0.33
2
0.16-0.68 | |
Contacts to outpatient services with any
| 2008-09 |
3.07 2.70-3.48 |
3.38 2.83-4.03 |
3.03 2.59-3.54 |
0.91 0.73-1.32 |
1.01 0.84-1.22 |
1.12 0.88-1.42 |
diagnosis
| 2009-10 |
2.91 2.55-3.34 |
3.68 3.30-4.11 |
3.65 2.96-4.49 |
0.79
2
0.67-0.94 |
0.80 0.63-1.01 |
1.01 0.80-1.27 |
IRR
|
0.95 0.81-1.11 |
1.09 0.95-1.25 |
1.20
2
1.22-1.29 |
0.87 0.71-1.07 |
0.78
1
0.66-0.94 |
0.90 0.78-1.04 | |
Contacts to outpatient services with
| 2008-09 |
0.16 0.11-0.24 |
0.28 0.19-0.40 |
0.19 0.12:0.30 |
0.59
1
0.35-0.99 |
0.86 0.48-1.57 |
1.47 0.83-2.62 |
a lung-related diagnosis
| 2009-10 |
0.22 0.13:0.36 |
0.28 0.17-0.46 |
0.26 0.19-0.38 |
0.78 0.67-0.94 |
0.83 0.45-1.54 |
1.07 0.59-1.92 |
IRR
|
1.35 0.76-2.40 |
1.02 0.67-1.54 |
1.41
2
1.13-1.74 |
1.33 0.65-2.70 |
0.95 0.51-1.81 |
0.72 0.46-1.15 |