Patient self-management in primary care patients with MRC I/II COPD - a randomised controlled trial of telephone health coaching
Most COPD self-management trials have identified patients from secondary care populations and patients with moderate to severe breathlessness. This trial assessed the effectiveness of telephone health coaching to encourage self-management in primary care patients with mild symptoms of COPD.
Multi-centre randomised controlled trial of COPD patients with mild dyspnoea (MRC grade 1/2) recruited from primary care. Intervention: Nurse-delivered telephone health coaching package with four calls over 3 months and included four components: accessing smoking cessation services, increasing physical activity, medication management and action planning. The intervention was underpinned by behaviour change theory and intervention participants received written materials, a pedometer and a self-monitoring log. The usual care group received a standard leaflet about managing COPD. Outcomes: Primary – HRQoL at 1-year (SGRQ-C). Secondary - self-reported smoking and physical activity, anxiety, depression, MRC dyspnoea scale, self-efficacy, EQ-5D-5L, health care utilisation, accelerometry to measure physical activity.
577 participants from 71 general practices were randomised to intervention (289) and usual care (288). 29% had MRC dyspnoea 1 and 71% MRC 2; total SGRQ-C mean score 28.7 (SD 14.6). Intervention delivery: 86% of the scheduled calls were delivered and 75% of participants received all four calls. Follow-up: 89% at 12 months.There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95%CI -3.6, 0.9; p=0.2). In the intervention group at 6-months self-reported physical activity was significantly higher, more participants had a care plan, rescue packs of antibiotics and had had their inhaler technique checked within the past 6-months.
A novel telephone health coaching intervention to promote behaviour change in patients with mild symptoms of dyspnoea in primary care did lead to some changes in self-management activities, but did not improve health related quality of life.