The Danish Structural Reform in 2007 delegated the responsibility for prevention and rehabilitation to the municipalities. This demanded a new structure which needed to be multidisciplinary and coordinated between the sectors to create transparent treatment through the whole healthcare system.
In a large study we examined how structures were created with an extra effort from the Ringkøbing-Skjern municipality, the Central Denmark Region and with general practice as coordinator for the care for patients with COPD.
In this study there was no change for the patients in any of the groups or when comparing the difference between groups in the EQ-5D index score before and after the intervention. In the intervention group, the MRC score decreased from 2.11 to 2.08 (difference=-0.03 [95%CI: -0.13;0.08]), while an increase of 0.14 [95% CI: 0.02;0.25] was seen in the control group. The effect of the intervention was a decrease in the MRC score of -0.16 [95%CI: -0.32;-0.01], (p=0.043).
The British Research Council’s model for developing complex interventions was used for a multifaceted implementation strategy for a disease management program for COPD. Based on principles from the Chronic Care Model, the Breakthrough Series, academic detailing, continued medical education and identification of the patients were used. The active implementation model was tried in a randomised controlled trial.
Patients scored their HRQOL with the generic instrument EQ-5D as one measure of health status. Furthermore did the patients score the MRC dyspnoea score – which is regularly used in general practice to assess HRQOL.
Our results show that while an active implementation of a disease management programme for the chronic disease COPD was associated with improvements in the disease-specific health status measured with the MRC dyspnoea score; this was not reflected in the generic health status measured with EQ-5D. This indicates that the active implementation of a disease management programme had the intended effect in raising the health status of patients concerning their COPD.
The gained knowledge of how the delivery of comprehensive care with general practice as the coordinator for COPD care increased the patients’ health status can be used to implement disease management programs for other chronic diseases.