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Disease management for COPD: Avoiding hospitalizations and controlling cost?

COPD is recognized worldwide as a major public health problem. The disease is known for its progressive course with “flare ups” called COPD exacerbations, which necessitate a change in regular medication (1) with more severe exacerbations requiring hospital admission (2). The increased prevalence of COPD, which is expected to continue over the next several decades, will lead to further stress on healthcare systems worldwide (3,4). There is an urgent need to introduce substantial changes in delivery of care for patients with chronic diseases such as COPD. Disease management (DM) has been proposed to enhance management of patients with chronic medical problems. DM programs are coordinated health care interventions for chronic medical conditions such as COPD, in which patient self-management plays a major role. The goals are to teach the skills needed to carry out medical regimens specific to a long term disease and to guide behavior change to help patients control their own condition and improve their well being (4,5). To enable a shift towards increased self-management, patients have to be provided with the necessary tools (e.g. action plans, access to a case manager) and gain confidence, “self-efficacy”, to apply the acquired skills on a daily basis. In addition to improving health outcomes, a major objective of DM is to improve health care quality and control costs, for example by avoiding hospitalizations. A systematic review (6) has confirmed that self-management education, as part of multiple components of the chronic care model (delivery system, decision support, and clinical information system), is an effective strategy to reduce health care use in COPD, while interventions that apply self-management alone are unlikely to show benefits on outcomes such as emergency department visits and hospital admissions. Trials that have included selfmanagement embedded in an integrated health care system,