A44-43 Understanding the Implementation and Efficacy of Integrated Models of Care for Chronic Obstructive Pulmonary Disease: A Systematic Review

Rationale Despite increasing evidence for integrated care models for chronic obstructive pulmonary disease (COPD), substantial heterogeneity exists in their design, delivery, and core components. This systematic review aimed to explore the implementation of care models among health disciplines and services, and their effectiveness for people with COPD. Methods Three databases (Medline, Embase and Emcare) were systemically searched on 8 September 2024 and updated on 17 September 2025 for quantitative studies evaluating integrated, multi-component models of care for COPD involving vertical integration (between primary, secondary or tertiary settings), and/or horizontal integration (between different healthcare disciplines or specialties). Key outcomes included the implementation of care models and their impact on healthcare utilization, quality of life and mortality. Results Of 15,170 citations identified, 67 articles were included (22 randomised controlled trials, 45 non-randomised studies) describing 57 care models (n = 37,721, 62.7% men). Thirty (52.6%) models incorporated both horizontal and vertical integration. Forty-five (78.9%) models were initiated in the hospital, with the majority (n = 41, 91.1%) led by respiratory medicine. Twelve (21.1%) models were initiated in primary care. Thirty (52.6%) models were led by specialists, while 17 (29.8%) were delivered by nurses and allied health professionals. Thirty-six (63.2%) models provided telehealth services and 22 (38.6%) included home visits. The most common care components delivered were education and self-management (n = 56, 98.2%), physical activity and pulmonary rehabilitation (n = 46, 80.7%), and vaccination and smoking cessation (n = 37, 64.9%). Oxygen therapy and ventilatory support (n = 11, 19.3%), palliative care (n = 13, 22.8%), and nutritional support (n = 17, 29.8%) were less prevalent. Frequency of acute exacerbation was the most frequently measured outcome (n = 45, 78.9%), with 21 (46.7%) studies demonstrating significant improvement. Thirteen (19.4%) studies examined healthcare costs, of which only 2 (15.4%) reported a significant reduction. FEV1 was measured in 17 (25.4%) studies, with the majority (n = 13, 76.5%) showing no significant change. Patients’ quality of life was assessed in 36 (53.7%) studies, with 21 (58.3%) reporting significant improvement. Mortality was reported in 21 (31.3%) studies, with 9 (42.8%) demonstrating significant improvement. Only 3 (4.5%) studies measured carers’ quality of life. Conclusion The integrated models of care for COPD demonstrated significant heterogeneity in their implementation and clinical settings, leading to variable efficacy in healthcare utilization, quality of life and mortality. Key components such as palliative care and oxygen therapy remain under-utilised, and carer’s needs are often under-recognized. A successful model must be tailored to individual patient needs and local healthcare contexts to optimise care delivery and efficiency.