Training to manage respiratory disease saves money

Training to manage respiratory disease saves money


 A study proves the efficacy and cost/effectiveness of a one-month outpatient disease education program in patients with COPD.

A randomized controlled trial of Ninot and colleagues published in the journal Respiratory Medicine in 2011 tested the benefits of exercise based on the Hospital of Montpellier with 38 patients therapeutic education program with Chronic Obstructive Pulmonary Disease (COPD). The results show an improvement in physical autonomy and quality of life of participants with the program. After one year, these improvements are still present and are accompanied by a decrease in unscheduled drug treatments (saving € 481 per year and per patient). This study provides evidence that a disease management education program improve physiological and psychological indicators and reduce  healthcare costs in the year following implementation of the program. However, it is not strong enough to change the number or duration of hospitalization.

The Study Rationale

The Chronic Obstructive Pulmonary Disease (COPD) is the fifth leading cause of death worldwide. It affects a million and a half people in France. The cause of this disease is mainly active or passive smoking. COPD is currently not curable. Over the COPD diagnosis is delayed, the more collateral damage is important. These consequences require a long-term care and change in health behaviors. However, 50%  of patients with COPD do not properly follow their treatment. 75 to 85% of them do not change their lifestyle after diagnosis. Then, they continue to suffer from shortness of breath. They contract new symptoms such as fatigue, anxiety, depression, sleep disorders, overweight. They require unscheduled consultations, emergency care and hospitalizations.

To counter these effects, it was long thought that information given by a physician or an disease information document was sufficient to adopt and maintain self-care and positive health behaviors. But that is not the case. The disease management education referred informational only benefit some patients, usually those who have had contact with the healthcare environment. This learning should theoretically go through phases of information followed by practical cases, it is the goal of this study.

Patient education does it save money while benefiting COPD patients?

The Question

A disease management education program of 8 sessions in the hospital is effective to reduce breathlessness, to increase physical independence and to improve quality of life for COPD patients while reducing hospitalizations and unscheduled treatment?

The Protocol

The randomized controlled trial tests the efficacy of a disease management education program. It consists of 2 sessions per week in the hospital for a month. Group sessions of 2 hours include practical information and an introduction to exercise at VT, nutrition tips and practical information on self-management of COPD. Participants are encouraged to continue these activities at home. The control group follows the recommendations and conventional treatments. The study compared 18 patients with COPD participated in therapeutic education program in 20 patients without the intervention randomized. The analyzes focus on the exercise tolerance test using the six-minute walk, quality of life measured with the Saint George Respiratory Questionnaire (SGRQ) and the direct costs of unscheduled care during the year following the program.

Main results

The results of this non-drug test showed statistically significant benefits of therapeutic education group compared with the control group at the end of the program. These benefits persist after one year at the exercise tolerance (towards average 30 m walk test six minutes for therapeutic Education group) and quality of life (improved to 7.6 Total score St. George questionnaire for the therapeutic education group). Furthermore, the results show no decrease in the number of hospital days a year of the reduced costs of unscheduled medication therapeutic education program, just (€ 481 on average per year per patient).

A disease management program improves the quality of life of COPD patients while allowing a saving on average of 481 euros per year and per patient.

What it means for Patients

This study demonstrates that awareness of physical activity as part of a therapeutic education program is beneficial for patients with COPD. Follow a therapeutic education program including specific messages about physical activity a month in hospital to better understand the disease and to adopt behaviors that will improve the quality of life and physical autonomy.

What it means for Healthcare Professionals

Eight outpatient sessions in a month in a hospital therapeutic education center associated with awareness at VT adapted physical activity sufficient to improve exercise tolerance and quality of life of COPD patients. These benefits persist after one year. It saves € 481 per year per patient unscheduled pharmacological treatments. This is one of the first studies showing French medico-economic effectiveness of a therapeutic education program.

The message for Researchers

Ten years have elapsed between the beginning of the study and its publication. As for patients, as the part of health professionals and researchers, non-drug intervention research deserves to be better known and better helped. In any case, the researcher must be patient in this kind of study.

What it means for Policymakers

Eight sessions of therapeutic education and awareness adapted physical activity enough to improve physical functioning and quality of life of patients with COPD. This program saves € 481 per year per patient of unscheduled care. The rise of therapeutic education in COPD no longer suffer from discussions with this kind of study.

The reference

Ninot G, Moullec G, Picot MC, Jaussent A, Hayot M, Desplan M, Brun JF, Mercier J, Prefaut C (2011). Cost-saving effect of supervised exercise associated to COPD self-management education program. Respiratory Medicine, 105, 377-385.

To reference this Blog en Sante © article.

Ninot G (2014). Training to manage respiratory disease saves money. Blog en Sante, A6.

© Copyright 2014 Grégory Ninot. All rights reserved.

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