Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care

Abstract

Objective: Assessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care.

Methods: A pragmatic cluster randomised controlled trial, in 39 Dutch primary care practices and 17 hospitals, with 357 patients with COPD (postbronchodilator FEV1/FVC ratio <0.7) aged ≥40 years, who could understand and read the Dutch language. Healthcare providers were randomly assigned to the intervention or control group. The intervention group applied the ABC tool, which consists of a short validated questionnaire assessing the experienced burden of COPD, objective COPD parameter (eg, lung function) and a treatment algorithm including a visual display and treatment advice. The control group provided usual care. Researchers were blinded to group allocation during analyses. Primary outcome was the number of patients with a clinically relevant improvement in SGRQ score between baseline and 18-month follow-up. Secondary outcomes were the COPD Assessment Test (CAT) and the Patient Assessment of Chronic Illness Care (PACIC; a measurement of perceived quality of care).

Results: At 18-month follow-up, 34% of the 146 patients from 27 healthcare providers in the intervention group showed a clinically relevant improvement in the SGRQ, compared with 22% of the 148 patients from 29 healthcare providers in the control group (OR 1.85, 95% CI 1.08 to 3.16). No difference was found on the CAT (-0.26 points (scores ranging from 0 to 40); 95% CI -1.52 to 0.99). The PACIC showed a higher improvement in the intervention group (0.32 points (scores ranging from 1 to 5); 95% CI 0.14 to 0.50).

Conclusions: This study showed that use of the ABC tool may increase quality of life and perceived quality of care.

Trial registration number: NTR3788; Results.

Keywords: Chronic Obstructive Pulmonary Disease; Communication tool; Disease Management; Patient-centred care; Quality of Life; Shared Decision Making.

Figure 1

Visualisation of the integrated health status of a patient with COPD. The green balloons towards the top of the figure indicate a satisfactory score in that domain, whereas the red balloons signify a low score and orange balloons an intermediate score. Grey balloons are the balloons of previous visits which provide the opportunity to monitor over time. The five domains of experienced burden of COPD, as measured with the ABC scale, are represented by the last five balloons, symptoms, functional status, mental status, fatigue and emotions. Dyspnoea (evaluated by the Medical Research Council (MRC) scale18) and level of physical activity are also reported by the patients. Smoking status, exacerbations, body mass index (BMI) and lung function are reported by the healthcare providers.

Figure 2

Flow chart of patients in the study. ABC tool, Assessment of Burden of COPD tool; ICR, interquartile range; SGRQ, St. George's Respiratory Questionnaire.

Figure 3

Comparison of clinically relevant improvement and deterioration on the SGRQ, after 6, 12 and 18 months between the intervention and control group, including percentages of patients at different time points with no clinically relevant change.

Figure 4

(A) Mean change in observed SGRQ total scores at 6-month, 12-month and 18-month follow-up compared with baseline, with a higher score indicating worse quality of life. (B) Mean change in predicted SGRQ total scores at 6-month, 12-month and 18-month follow-up compared with baseline, with a higher score indicating worse quality of life. SGRQ, St. George's Respiratory Questionnaire.