A systematic diagnostic evaluation combined with an internet-based self-management support system for patients with asthma or COPD

Abstract

Introduction

An (inter)national systematic approach for patients with asthma COPD referred to secondary care is lacking. Therefore, a novel systematic approach was designed and tested in clinical practice.

Methods

This was a retrospective observational study of data from the electronic record system of the Leiden University Medical Center. Asthma and COPD patients were included if they were evaluated with a novel systematic approach or if they had a new record for asthma or COPD and received usual care. The novel systematic approach consisted of a predefined diagnostic evaluation combined with an optional internet-based self-management support system. Diagnostic tests, final diagnosis, lifestyle advices, symptoms and individual care plans in the electronic records, number of patients referred back to primary care, and time to referral back to primary care were compared between the systematic approach and usual care groups using t-tests and chi-squared tests.

Results

A total of 125 patients were included, of which 22 (21.4%) were evaluated with the systematic approach. Mean (±SD) age was 48.8 (±18.4) years and 59.2% were women. Mean (±SD) number of diagnostic tests was higher in the systematic approach group compared with the usual care group (7.6±1.0 vs 5.5±1.8, P<0.001). Similarly, in the systematic approach group, more lifestyle advices (81.8% vs 29.1%), symptom scores (95.5% vs 21.4%), and individual care plans (50.0% vs 7.8%) were electronically recorded (P<0.001), and more patients were referred back to primary care (81.8% vs 56.3%, P=0.03). There were no differences in the final diagnoses and time to referral back.

Conclusion

Our study suggested that not all tests that were included in the systematic approach are regularly needed in the diagnostic work-up. In addition, a designated systematic approach stimulates physicians to record lifestyle advices, symptoms, and individual care plans. Thus, this approach could increase the number of patients referred back to primary care.

Keywords:

• asthma
• COPD
• diagnostics
• eHealth
• outpatient clinic
• systematic approach

Supplementary materials

Table S1 Final diagnosis, phenotypes, and treatment plans in the diagnostic pathway compared to usual care

Table S2 Time between referral, first visit, final diagnosis, latest diagnostic test, and referral back to primary care

Acknowledgments

The authors would like to thank C van der Meij (nurse practitioner, Department of Pulmonology, LUMC, Leiden, the Netherlands) for the clinical assessment of patients, Dr JK Sont (associate professor, Department of Medical Decision Making, LUMC, Leiden, the Netherlands) for the availability of Patient-Coach, Dr JB Snoeck-Stroband (GP, Department of Medical Decision Making, LUMC, Leiden, the Netherlands) for a GP’s view on the diagnostic approach, and CE Schmidt (Advisor eHealth and Innovation, Department of Quality and Patient Safety, LUMC, Leiden, the Netherlands) for communication between different departments of the LUMC. This study was supported by Novartis with an unrestricted research grant.

Author contributions

Design of the study: ARvB, TNB, MJK, AMS, NHC, and CT. Data analysis: ARvB and TSW. Data interpretation: ARvB, TSW, TNB, MJK, AMS, NHC, and CT. Drafting the manuscript: ARvB, TSW, and TNB. Revision of the manuscript: ARvB, MJK, AMS, NHC, and CT. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.