Self management of patients with mild COPD in primary care: randomised controlled trial

Kate Jolly, Manbinder S Sidhu, Catherine A Hewitt, Peter Coventry, Amanda Daley, Rachel Jordan, Carl Heneghan, Sally Singh, Natalie Ives, Peymane Adab, Susan Jowett, Jinu Varghese, David Nunan, Khaled Ahmed, Lee Dowson, David Fitzmaurice

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate the effectiveness of nurse-led telephone health coaching to encourage self-management in a primary care population with mild symptoms of COPD.
Design: Pragmatic, multi-centre randomised controlled trial.
Setting: 71 general practices in four areas of England.
Participants: 577 people, with MRC dyspnoea grade 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis, were randomised to the intervention (n=289) or usual care (n=288).
Interventions: Nurse-delivered telephone health coaching intervention, underpinned by Social Cognitive Theory, promoting: accessing smoking cessation services, increasing physical activity, medication management and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). Nurses received two days of training. The usual care group received a leaflet about COPD.
Main outcome measures: The primary outcome was health related quality of life at 12 months using the short version of the St Georges Respiratory Questionnaire (SGRQ-C).
Results: The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of participants received all four calls. 92% participants were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95%CI -3.6 to 0.9; p=0.2). Compared to usual care participants, at six months follow-up, the intervention group reported significantly greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%) and inhaler technique check (68% v 55%). There were no differences in other secondary outcomes (dyspnoea, smoking cessation, anxiety, depression, self-efficacy, objectively measured physical activity).
A novel telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self-management activities, but did not improve health related quality of life.

Original languageEnglish
Article numberk2241
Number of pages14
Publication statusPublished - 13 Jun 2018

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