Annerika Slok

Development of the Assessment of Burden of COPD tool: an integrated tool to measure the burden of COPD

In deciding on the treatment plan for patients with chronic obstructive pulmonary disease (COPD), the burden of COPD as experienced by patients should be the core focus. It is therefore important for daily practice to develop a tool that can both assess the burden of COPD and facilitate communication with patients in clinical practice. This paper describes the development of an integrated tool to assess the burden of COPD in daily practice. A definition of the burden of COPD was formulated by a Dutch expert team. Interviews showed that patients and health-care providers agreed on this definition. We found no existing instruments that fully measured burden of disease according to this definition. However, the Clinical COPD Questionnaire meets most requirements, and was therefore used and adapted. The adapted questionnaire is called the Assessment of Burden of COPD (ABC) scale. In addition, the ABC tool was developed, of which the ABC scale is the core part. The ABC tool is a computer program with an algorithm that visualises outcomes and provides treatment advice. The next step in the development of the tool is to test the validity and effectiveness of both the ABC scale and tool in daily practice.

Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care

Objective Assessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. Georges Respiratory Questionnaire (SGRQ), compared with usual care. Methods A pragmatic cluster randomised controlled trial, in 39 Dutch primary care practices and 17 hospitals, with 357 patients with COPD (postbronchodilator FEV1/FVC ratio <0.7) aged ≥40 years, who could understand and read the Dutch language. Healthcare providers were randomly assigned to the intervention or control group. The intervention group applied the ABC tool, which consists of a short validated questionnaire assessing the experienced burden of COPD, objective COPD parameter (eg, lung function) and a treatment algorithm including a visual display and treatment advice. The control group provided usual care. Researchers were blinded to group allocation during analyses. Primary outcome was the number of patients with a clinically relevant improvement in SGRQ score between baseline and 18-month follow-up. Secondary outcomes were the COPD Assessment Test (CAT) and the Patient Assessment of Chronic Illness Care (PACIC; a measurement of perceived quality of care). Results At 18-month follow-up, 34% of the 146 patients from 27 healthcare providers in the intervention group showed a clinically relevant improvement in the SGRQ, compared with 22% of the 148 patients from 29 healthcare providers in the control group (OR 1.85, 95% CI 1.08 to 3.16). No difference was found on the CAT (−0.26 points (scores ranging from 0 to 40); 95% CI −1.52 to 0.99). The PACIC showed a higher improvement in the intervention group (0.32 points (scores ranging from 1 to 5); 95% CI 0.14 to 0.50). Conclusions This study showed that use of the ABC tool may increase quality of life and perceived quality of care. Trial registration number NTR3788; Results.

ABC Index: quantifying experienced burden of COPD in a discrete choice experiment and predicting costs

Objective The Assessment of Burden of COPD (ABC) tool supports shared decision making between patient and caregiver. It includes a coloured balloon diagram to visualise patients’ scores on burden indicators. We aim to determine the importance of each indicator from a patient perspective, in order to calculate a weighted index score and investigate whether that score is predictive of costs. Design Discrete choice experiment. Setting and participants Primary care and secondary care in the Netherlands. 282 patients with chronic obstructive pulmonary disease (COPD) and 252 members of the general public participated. Methods Respondents received 14 choice questions and indicated which of two health states was more severe. Health states were described in terms of specific symptoms, limitations in physical, daily and social activities, mental problems, fatigue and exacerbations, most of which had three levels of severity. Weights for each item-level combination were derived from a Bayesian mixed logit model. Weights were rescaled to construct an index score from 0 (best) to 100 (worst). Regression models were used to find a classification of this index score in mild, moderate and severe that was discriminative in terms of healthcare costs. Results Fatigue, limitations in moderate physical activities, number of exacerbations, dyspnoea at rest and fear of breathing getting worse contributed most to the burden of disease. Patients assigned less weight to dyspnoea during exercise, listlessness and limitations with regard to strenuous activities. Respondents from the general public mostly agreed. Mild, moderate and severe burden of disease were defined as scores <20, 20–39 and ≥40. This categorisation was most predictive of healthcare utilisation and annual costs: €1368, €2510 and €9885, respectively. Conclusions The ABC Index is a new index score for the burden of COPD, which is based on patients’ preferences. The classification of the index score into mild, moderate and severe is predictive of future healthcare costs. Trial registration number NTR3788; Post-results.

Ziektelastmeter COPD tijdens het consult

SamenvattingUit onderzoek blijkt dat het gebruik van de Ziektelastmeter COPD tijdens het consult leidt tot betere kwaliteit van leven en betere kwaliteit van zorg. Patiënten en zorgverleners zijn zeer tevreden over het instrument. Daarom heeft de Long Alliantie Nederland besloten de implementatie ervan te bevorderen.

De Ziektelastmeter COPD als hulpmiddel in de praktijk

SamenvattingSlok AHM, Kotz D, Chavannes NH, Snoeck-Stroband JB, Salomé PL, In ’t Veen JCCM, Van Schayck OCP. De Ziektelastmeter COPD als hulpmiddel in de praktijk. Huisarts Wet 2017;60(10):500-2. De Ziektelastmeter COPD geeft de gezondheidstoestand van de COPD-patiënt inzichtelijk weer in een diagram met elf ballonnen die elk staan voor een fysiologisch, psychisch of functioneel domein. De ziektelastmeter maakt het mogelijk in samenspraak met de patiënt het behandelplan te monitoren en uit te werken, zodat de patiënt zelf gericht aan de slag kan. Effectonderzoek toont aan dat gebruik van de ziektelastmeter leidt tot een betere kwaliteit van leven en een hogere ervaren kwaliteit van zorg. Ziektelastmeting is opgenomen in de Zorgstandaard COPD en de NHG-Standaard COPD en wordt momenteel geïmplementeerd in huisartsenpraktijken en ziekenhuizen.

Assessment of Burden of COPD tool : evidence not perception

We thank Houben-Wilke et al. [1] for their comments on the Assessment of Burden of COPD (ABC) tool. They raised questions about the purpose of the ABC tool. The aims of ABC were clarified before its development, in the study protocol [2]. The ABC tool is multifaceted and was developed to measure burden of disease, facilitating shared decision making and formulation of a personal treatment plan [2–5]. All of these purposes relate to increasing self-management and stimulating behavioural change, which are, most often, important components of individual treatment plans. The goal of most treatment plans is to increase health status. Health status was therefore the primary outcome of our study [2–5]. ABC tool affects HRQoL and quality of primary/secondary COPD care but has not been tested in tertiary settings http://ow.ly/HZYF30cmTsx