Abstract

Background: Integrated disease management (IDM) is an effective, multidisciplinary, multicomponent approach to COPD including self-management action plans. It is not known if exacerbation prone individuals should receive exacerbation medication prescriptions (EMPs), oral corticosteroids and/or antibiotics, when the action plan is provided.

Objective: To evaluate self-management strategies in an established primary-care based IDM program to identify i) if EMPs are available to the exacerbation prone target population and, ii) to compare acute health service utilization (HSU) in the EMP vs no EMP groups.

Method: In this retrospective cohort study, we included all patients managed with Best Care IDM in Ontario (2016-2022). Demographic, clinical characteristics, and HSU were compared in the EMP vs no EMP groups for the whole cohort and in a subset of exacerbation prone individuals.

Results: All participants received IDM and 100% (2560) had a self-management action plan. Participants with an EMP (482/2560,19%) vs no EMP (81%) had more severe COPD: mean FEV1, 54.5% vs 62.9%, GOLD E 48% vs 18%, mean COPD Assessment Test 17.6 vs 15.7. Univariable analysis of the exacerbation prone subset (1341,52%), comparing year pre to year post IDM, there was a larger mean reduction in hospitalizations per patient with an action plan plus EMP -0.26(95%CI;-0.33, -0.18) vs action plan with no EMP -0.15( 95%CI;-0.19,-0.11), a relative reduction of 68% vs 61%. However, in the multivariable analysis, adjusted for disease severity, no effect of EMP was observed.

Conclusion: Where there are accessible supports for patients with COPD, an action plan without an EMP is as effective as an action plan with an EMP.