Optionally, an additional team member (such as a dietitian or pulmonary specialist) could attend the course if they expressed interest.
Elements of the course included performing/interpreting spirometry, assessment of disease burden, review of advice from international guidelines, motivational interviewing to stimulate a healthier lifestyle, and smoking cessation.
The intervention was delivered at the cluster level.
General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice.
As COPD is a disease with increasing prevalence, and general practitioners and family physicians treat most patients, well designed studies of pragmatic integrated disease management programmes in primary care are essential.
However, in COPD trials, the participants commonly comprise a small and selected fraction of the real world population, resulting in leading medical journals calling for studies in more representative patient populations.6 7 The few studies of integrated disease management in primary care recruited patients in secondary care,8 9 10 11 consisted of palliative programmes for severe patients,12 13 had a short duration of intervention,9 10 11 12 14 or did not correct for cluster analysis.15 The true effect of integrated disease management in primary care thus remains inconclusive.
At the end of the second day, each practice team designed a specific time contingent plan in a group discussion with their multidisciplinary members.
Exacerbation rates as well as number of days in hospital did not differ between groups.
General practitioners were recruited from the western part of the Netherlands.
Patients in both groups received an information leaflet stating that the aim of the study was to improve treatment of COPD in primary care and that general practitioners were randomised to two groups.
If spirometry data were not of sufficient quality or not available, patients were invited to participate for a lung function assessment, according to the American Thoracic Society/European Respiratory Society guidelines for spirometry.17 Exclusion criteria were terminal illness, cognitive impairment, hard drug or alcohol misuse, and inability to fill in questionnaires.
Recruitment of practices started in September 2010 and was finished in September 2011.