Patient self-management in primary care patients with MRC I/II COPD - a randomised controlled trial of telephone health coaching

Conference:

SAPC ASM 2017 - Warwick

Talk Code:

4C.2

Presenter:

Kate Jolly

Co-authors:

Manbinder Sidhu, Catherine Hewitt, Amanda Daley, Rachel Jordan, Peter Coventry, Carl Heneghan, Sue Jowett, Sally Singh, Natalie Ives, Peymane Adab, Jinu Varghese, David Nunan, Khaled Ahmed, David Fitzmaurice

Author institutions:

University of Birmingham, University of York, University of Oxford, University of Warwick, University Hospitals Leicester

Problem

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.

Approach

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.

Findings

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.

Consequences

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.

Submitted by:

Kate Jolly

Funding acknowledgement:

This paper summarises independent research funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Kate Jolly is part-funded by the NIHR CLAHRC) West Midlands; Sally Singh is part-funded by the CLAHRC- East Midlands.