Structured telephone intervention to improve the self-management in COPD patients in primary level of health care

Azra Gicic, Katerina Kovachevikj, Sashka Janevska, Marta Tundzeva, Katarina Stavrikj, Sasho Stoleski

Keywords: COPD, self-management, family doctors, telephone coaching, primary level of health care

Background:

The COVID-19 pandemic showed that the telephonic consultation is well accepted among the chronic patients. The prevalence of COPD in North Macedonia is 7.16%. The COPD is the third most common reason for the patients’ visits to their family doctor ambulance, second most common reason for referral to a secondary healthcare system and the first reason in hospitalization of patients in North Macedonia.

Research questions:

The structural telephone intervention to COPD patients by their family doctors in primary health care will improve the control of the disease and the quality of life compared to the standard health care protocol.

Method:

Randomized controlled study in 24 family medicine ambulances in Skopje including 240 patients older than 18 with mild form of COPD (GOLD1 and GOLD2) confirmed with spirometry and ≤1 exacerbations without hospitalization. In 120 patients will be performed telephone intervention SAPHA by GP (smoking cessation advice, adherence to therapy, physical activity, action plan and prevention of infections) and the other 120 will get the standard health care. The telephone intervention will take place in the first , 2nd, 4th and 12th week since the begin of the study.
In all of the patients within the 0, 6th and 12th month we will evaluate quality of life, COPD symptoms, dyspnea level and psychical activity with the use of 4 internationally standardized questionnaires.

Results:

The primary outcome is related to the quality of life measures using St.Georges respiratory questionnaire (SGEQ) score at 12 months from baseline. The secondary outcomes measures health habits (smoking and psychical activity), adherence to therapy and symptoms control using the mMRC and CAT, depression and anxiety level, number of exacerbations and antibiotics prescriptions at six and 12 months.

Conclusions:

We expect improvement of quality of the live using self-care management in patients with mild form of COPD in primary heath care.

Points for discussion:

What precautions should be taken to prevent bias?

Is one year enough to achieve in improvement of life-quality ?