Effects of case management on hospitalisation and exacerbation rate in severe, complex COPD: A randomized controlled trial

Background: Acute exacerbations have negative effects on lung function, physical performance, dyspnoea, and quality of life. Patients with severe COPD and co-morbidities are especially vulnerable to exacerbations. Aim: We investigated if a case manager could reduce number and duration of hospital admissions due to exacerbations of COPD. Method: In this RCT, 81 COPD patients GOLD stage 3-4 and co-morbid disease, with ≥ 1 reported exacerbation in the past two years were randomised to usual care or a case management care condition. In the usual care condition, patients visited the pulmonary nurse every 3 to 6 months. In the case manager condition, the pulmonary nurse started with a home visit, and contacted patients at least every 6 weeks by phone. Basic self-management techniques were taught and an exacerbation action plan was offered to the patient and all health care providers. Results: Number and duration of hospital admissions were not lower in the experimental condition. The number of exacerbations reported by the general practitioner did not differ significantly. No differences were found between the two conditions with respect to health status measured by the CRQ. There was major drop out in both groups (42%), main reason was death (53%). Patients were more satisfied with the experimental condition, particularly because the case manager helped coordinating the complex care by many professionals. Conclusion: Positive benefits on health status and hospital admission rates and duration were not found. However, patients with severe COPD and multiple comorbidities benefit from a case manager by structuring care in a better way leading to increased patient satisfaction.