Identifying potentially cost effective chronic care programs for people with COPD

Figures & data

Table 1 Search strategy

Combinations of MeSH and text words searched

“Disease management” [MeSH] “Disease management” “Disease state management” “Delivery of Health Care, Integrated” [MeSH] “Comprehensive Health Care” [MeSH:NoExp] “Patient Care Planning” [MeSH] NOT “Advance Care Planning” [MeSH] “Primary Health Care” [MeSH] NOT “Refusal to Treat” [MeSH] “Patient Care Team” [MeSH:NoExp] “Critical Pathways” [MeSH] “Case Management” [MeSH] “Continuity of Patient Care” [MeSH] “Practice Guidelines” [MeSH] “Guidelines” [MeSH] “Clinical Protocols” [MeSH:NoExp] “Patient Education” [MeSH] “Self Care” [MeSH:NoExp] “Reminder systems” [MeSH] “Health Education“ [MeSH] “Health Promotion” [MeSH:NoExp] “Community Health Planning” [MeSH] “Ambulatory Care” [MeSH] (Patient OR providers) AND feedback (Patient OR providers) AND reminder (Patient OR providers) AND monitor$ OR/1–24 “Epidemiologic Research Design” [MeSH] NOT “Sensitivity and Specificity” [MeSH] “Clinical Trials” [MeSH:NoExp] “Controlled Clinical Trials” [MeSH] “Randomized Controlled Trials” [MeSH] “Multicenter Studies” [MeSH] “Epidemiologic Studies” [MeSH] NOT “Seroepidemiologic Studies” [MeSH] “Pilot Projects” [MeSH] “Sampling Studies” [MeSH] “Program Evaluation” [MeSH] “Intervention Studies” [MeSH] “Evaluation Studies” [MeSH:NoExp] OR 26–36 Controlled Clinical Trial [pt] Clinical Trial [pt] Multicenter Study [pt] Randomized Controlled Trial [pt] Evaluation Studies [pt] Meta-analysis [pt] OR 38–43 37 OR 44 AND “Pulmonary Disease, Chronic Obstructive” [MeSH] 25 AND 45 Limit 47 to human Limit 48 to yr 1995–2007 Limit 49 to English

Table 2 Characteristics of studies included in the systematic review (clustered where) describing unique COPD programs

Author (year of publication)	Location	Setting (CC; PC; SC;TC)#	Population		Program type (CCM; DMP; not explicitly stated)^Table Footnoteχ	No. (types) of components (2 to 4; (Types^¶))	Study design	Study quality score (0–100)	Length of follow-up	Sample size at baseline		No completed
			Mean age (yrs ± sd)	Gold stage						I1/I2*	C	I1/I2*	C
Aiken et al (2006)^Citation20	United States	TC	68.5 (±13.5)	3 and 4	Not stated	3 (SMAN, DSYS, DSUP)	RCT	60	18 mo	100	90	43	30
Bourbeau et al (2003 and 2006)^Citation32,Citation34/Gadoury et al (2005)^Citation33	Canada	SC	69.5 (±7.0)	2 and 3	Not stated	3 (SMAN, DSYS, DSUP)	RCT	80 (both)/65	12 mo 24 mo	95	95	86B and 91G	79B and 84G
Casas et al (2006)^Citation38	SpainIBelgium	TC	71.2 (±9.0)	3 and 4	Not stated	4 (SMAN; DSYS, DSUP, CIS)	RCT	80	12 mo	65	90	48	72
Coultas et al (2005)^Citation21	United States	PC	69.0 (±8.2)	2 and 3	Not stated	3 (SMAN, DSYS, DSUP)	RCT	55	6 mo	72 72	73	51/49	51
Egan et al (2002)^Citation26	Australia	SC	67.5 (SD not stated)	1–3	DMP	4 (SMAN; DSYS, DSUP, CIS)	RCT	60	3 mo	33	33	25	28
Hermiz et al (2002)^Citation27	Australia	CC and PC	49.3 (SD not stated)	2 and 3	Not stated	2 (SMAN, DSYS)	RCT	65	3 mo	84	93	67	80
Hernandez et al (2003)^Citation37	Spain	SC and TC	70.8 (±9.7)	2 and 3	Not stated	2 (SMAN, DSYS)	RCT	65	8 wk	121	101	116	94
Hesselink et al (2004)^Citation35	The Netherlands	PC	47.3 (±13.9)	1–4	Not stated	2 (SMAN, DSYS)	RCT	80	24 mo	46	38	32	22
Jeffs et al (2005)^Citation28	Australia	SC	67.5 (SD not stated)	1–4	Not stated	2 (SMAN, DSYS)	CCT	55	12 mo	28	25	28	25
Lee et al (2002)^Citation39	China	TC	80.4 (±6.3)	1–3	Not stated	3 (SMAN, DSYS, DSUP)	RCT	65	6 mo	48	41	48	41
Poole et al (2001)^Citation30	New Zealand	SC	69.7 (±7.1)	3	Not stated	2 (SMAN, DSYS)	CCT	55	12 mo	16	16	15	13
Rea et al (2004)^Citation31	New Zealand	PC	68 (range 44–84)	2 and 3	DMP	4 (SMAN; DSYS, DSUP, CIS)	RCT	75	12 mo	83	52	71	46
Ries et al (2003)^Citation22	United States	TC	67.1 (±8.2)	3	Not stated	2 (SMAN, DSYS)	RCT	70	24 mo	87	87	82	73
Smith et al (1999)^Citation29	Australia	SC	69.9 (±1.2)	3	Not stated	2 (SMAN, DSYS)	RCT	80	12 mo	48	48	36	36
Solomon et al (1998)^Citation23/Gourley et al (1998)^Citation24	United States	SC	69.3 (±7.8)	3 and 4	DMP	2 (SMAN, DSYS)	RCT	60/60	6 mo	43	55	43	54
Steuten et al (2006)^Citation36	The Netherlands	PC and SC	61 (±14)	1–4	DMP	4 (SMAN; DSYS, DSUP, CIS)	CBA	70	12 mo	317	NA	222	NA
Weinberger et a1 (2002)^Citation25	United States	CC	62.4 (±11.1)	1–3	Not stated	3 (SMAN, DSYS, DSUP)	RCT	80	12 mo	185/130	138	149/105	111

# Abbreviations: CC, community care; PC, primary care; SC, secondary care; TC, tertiary care;

χ CCM, chronic care model; DMP, disease management program; SMAN, self-management; DSYS, delivery system design; DSUP, decision support; CIS, clinical information systems; PIP, population identification processes; MEM, process and outcome measurement, evaluation and management; RFEED, routine reporting and feedback loops.

*Notes: I₂, the 2nd intervention for trials with three study arms;

B denotes study of Bourbeau et al;

G denotes study of Gadoury et al.

Table 3 Reported intermediate and end outcomes: measures used and summary of findings

Outcome (n, number of studies reporting the outcome)	Measures§	Summary of findings [study references]
Process measures
Scheduled outpatient visits (n = 7)	Physician (GP) office visits[^Citation32,Citation21,Citation27,Citation37,Citation36]; Specialist/ outpatient hospital visits[^Citation32,Citation38,Citation37,Citation22,Citation36]; Nurse home visits[^Citation38,Citation27,Citation37]	+[^Citation27^(nurse home visits), ^Citation36] =[^Citation32,Citation38,Citation21,Citation27^(GP visits), ^Citation37,Citation22^(12 month follow-up)] −[^Citation22^(24 month follow-up)]
Medication prescriptions (n = 5)	Total prescribed COPD-related medication[^Citation37,Citation36]; new medications prescribed[^Citation23]; antibiotics[^Citation28,Citation31]; oral steroids[^Citation28,Citation31]; domiciliary oxygen[^Citation28]; inhaled bronchodilators[^Citation28]	+[^Citation37^(oxygen and nebulizer), ^Citation36] =[^Citation37,Citation28,Citation31,Citation23]
Amount of patient education provided (n = 5)	Self-management education[^Citation20,Citation36]; COPD education [^Citation20,Citation21,Citation27,Citation24]	+[^Citation20,Citation21,Citation27,Citation24,Citation36]
Coordination of care (n = 2)	Number of GP-arranged follow-ups[^Citation27]; Patient assessed change in coordination of care[^Citation36]	+[^Citation36] =[^Citation27]
Accessibility of care (n = 1)	Patient assessed change in accessibility of care[^Citation36]	+[^Citation36]
Intermediate outcomes
Disease specific knowledge (n = 5)	Deenen's respiratory knowledge questionnaire[M1,^Citation36]; Self-designed questionnaire (not validated)[^Citation20,Citation27,Citation37,Citation24]	+[^Citation20,Citation27,Citation37,Citation36] =[^Citation24]
Self-management behaviour (n = 4)	Self-designed questionnaire (not validated)[^Citation27,Citation35,Citation31,Citation36]; Patient-reported smoking cessation[^Citation35,Citation31,Citation36]; physical activity[^Citation36]; influenza vaccination[^Citation27]; pneumococcal vaccination[^Citation27]	+[^Citation36] =[^Citation27,Citation35,Citation31]
Medication compliance (n = 4)	Self-designed questionnaire (not validated)[^Citation37,Citation35,Citation36,Citation25]; Single-item[M2,^Citation25] and 4-point Likert scale questionnaire[M3,^Citation25]	+[^Citation36] =[^Citation37,Citation35,Citation25]
Technical skills/self-efficacy (n = 4)	COPD Self-Efficacy Scale[M4,^Citation21,Citation35]; Coping style questionnaire[M5, ^Citation35]; Inhalation checklist[M6, ^Citation35]; Walking self-efficacy[M7, ^Citation22]; Self-designed questionnaire (not validated)[^Citation37]	+[^Citation37,Citation35^(inhalation)] =[^Citation21,Citation35^(self-efficacy and coping), ^Citation22]
Social support (n =2)	MOS social support survey[M8, ^Citation21,Citation26]	=[^Citation21,Citation26^(tangible and emotional support, positive social interaction)] −[^Citation26^(affectionate support)]
End outcomes
Lung function (n = 7)	Post bronchodilators FEV1(litres)[^Citation32,Citation31,Citation22,Citation29]; FEV1 (% predicted)[^Citation39,Citation31,Citation22,Citation29,Citation36]; FVC (litres); FEV1/FVC (%) [^Citation32] [^Citation32,Citation36]; PEF rate (% predicted)[^Citation25]	+[^Citation31,Citation25] =[^Citation32,Citation39,Citation36] −[^Citation22,Citation29] =[^Citation35,Citation30,Citation31,Citation29,Citation23,Citation25] −[^Citation22]
Dyspnoea (n = 7)	MRC dyspnoea questionnaire[M9, ^Citation35]; CRQ-dyspnoea dimension[M10, ^Citation30,Citation31,Citation25]; UCSD Shortness of Breath Questionnaire[M11, ^Citation22]; Baseline and Transition Dyspnoea Indices (interview administered)[M12, ^Citation22]; BORG scale[M13, ^Citation23]; Self-developed questionnaire (not validated)[^Citation29]
Symptoms (n = 9)	SGRQ-symptoms[M25, ^Citation32,Citation21,Citation26,Citation27,Citation37]; Memorial Symptom Assessment Scale[M26, ^Citation20]; General Health Questionnaire [M23, ^Citation39]; Symptoms checklist[M27, ^Citation35]; Self-developed questionnaire (not validated)[^Citation23]	=[^Citation20,Citation32,Citation21,Citation26,Citation27,Citation37,Citation35,Citation39,Citation23]
Physical functioning (n = 10) => Questionnaire based (n = 8) => Performance based (n = 2)	SF-36 physical functioning[M14, ^Citation20,Citation21,Citation31]; SF-12 physical functioning[M15, ^Citation37]; Barthel Index[M16, ^Citation39]; RAND-36 physical component[M17, ^Citation22]; COOP (adapted physical functioning item)[M18, ^Citation29]; Health Status Questionnaire[M19, ^Citation24] 6-minute walk test[M20, ^Citation32,Citation22]; Shuttle Walk Test[M21, ^Citation31]; Treadmill Test[^Citation22]	+ [^Citation20,Citation29] =[^Citation21,Citation37,Citation39,Citation31,Citation22,Citation24] +[^Citation22^(12 month follow-up)] =[^Citation32,Citation31,Citation22^(24 month follow-up)]
Mental functioning (n = 11)	SF-36 mental health[M14, ^Citation20,Citation21,Citation31]; HAD[M22, ^Citation26,Citation30]; Health Status Questionnaire [M19, ^Citation23]; SF-12 mental health [M15, ^Citation37]; General Health Questionnaire [M23, ^Citation39]; CRQ-emotion dimension [M10, ^Citation30,Citation31,Citation25]; CED-Depression Scale [M24, ^Citation22]; RAND-36 mental component [M17, ^Citation22]; COOP emotion components [M18, ^Citation29]	+[^Citation39,Citation22^(12 month follow-up), ^Citation29] =[^Citation20,Citation21,Citation26,Citation37,Citation30,Citation31,Citation22^(24 month follow-up), ^Citation29,Citation23,Citation25]
Health-related Quality of Life	SF-36[M14, ^Citation20,Citation21,Citation31]; SGRQ-total[M25, ^Citation32,Citation21,Citation26,Citation27,Citation37,Citation36]; CRQ-total[M10, ^Citation30,Citation31,Citation22,Citation25]; Subjective Well Being Scale[M28, ^Citation26]; Health Status Questionnaire[M19, ^Citation23]; SF-12[M15, ^Citation37]; QOL-RIO[M29,^Citation35]; General Health Questionnaire-total[M23, ^Citation39]; Quality of Well Being Scale[M30, ^Citation22]; COOP-total[M18, ^Citation21]; EQ–5D[M31, ^Citation36]	+[^Citation20,Citation32^(4 month follow-up), ^Citation37^(SGRQ), ^Citation30,Citation31^(CRQ-fatigue and mastery), ^Citation22^(12 month follow-up), ^Citation29,Citation36^(EQ-5D)] =[^Citation32^(12 month follow-up), ^Citation21,Citation26,Citation27,Citation37^(SF-12), ^Citation35,Citation39,Citation31^(SF-36), ^Citation22^(24 month follow-up), ^Citation36^(SGRQ), ^Citation25]
Health care utilization and costs (n = 19)	Hospital (re)admission[^Citation32,Citation33,Citation38,Citation21,Citation26,Citation27,Citation37,Citation28,Citation39,Citation30,Citation31,Citation29,Citation23,Citation36,Citation25]; Hospital LOS[^Citation37,Citation28,Citation39,Citation30,Citation31,Citation22]; ED-visits[^Citation20,Citation32,Citation33,Citation21,Citation27,Citation37,Citation28,Citation39,Citation31,Citation22,Citation29,Citation23,Citation25]; Unscheduled outpatient visits[^Citation32,Citation38,Citation21,Citation37,Citation22,Citation29,Citation23,Citation36]; Prescriptions[^Citation37,Citation28,Citation31,Citation23,Citation36]; Home visits[^Citation38]; Phone calls[^Citation22]; Sick leave[^Citation36]; Total costs[^Citation34,Citation37,Citation36]	+[^Citation37^(prescriptions), ^Citation28^(hospital LOS), ^Citation36^(prescriptions)] =[^Citation20,Citation34,Citation38,Citation21,Citation26,Citation27,Citation35^(outpatient visits), ^Citation28,Citation39,Citation30,Citation31, ^Citation22^(ED-visits), ^Citation29,Citation23,Citation36^(total costs), ^Citation25] −[^Citation32,Citation33,Citation38^(readmissions), ^Citation35,Citation30^(hospital LOS), ^Citation22,Citation23^(outpatient visits), ^Citation36]
Mortality (n = 14)	All causes death[^Citation20,Citation32,Citation34,Citation33,Citation38,Citation21,Citation27,Citation37,Citation35,Citation30,Citation31,Citation22,Citation29,Citation25]	=[^Citation20,Citation32,Citation34,Citation33,Citation38,Citation21,Citation27,Citation37,Citation35,Citation30,Citation31,Citation22,Citation29,Citation25]

§ Notes: References to included studies that applied this measure are indicated numerically; References to papers describing the validity/reliability of the measure or questionnaire are indicated with Mx.

M1 Deenen TAM. Patient health-education and self-management. Dissertation. Rijksuniversiteit Groningen, the Netherlands, 1996.

M2 Inui TS, et al Med Care. 1981;19:1061–64.

M3 Morisky DE, et al Med Care. 1986;24:67–74.

M4 Wigal JK, et al Chest. 1991;99:1193–6.

M5 Ketelaars CA,et al Thorax. 1996;51:39–43.

M6 Hesselink AE, et aI Scand J Prim Health Care. 2001;19:255–60.

M7 Kaplan RM, et al Health Psychol 1984;3:223–42.

M8 Sherbourne CD, et aI Soc Sci Med. 1991;32(6):705–14.

M9 Bestall JC, et al Thorax. 1999;54;581–6.

M10 Wijkstra PJ, et al Thorax. 1994;49(5):465–7.

Ml1 Eakin EG, et al Chest. 1998;113:619–24.

M12 Mahler DA, et aI Chest. 1984;85:751–8.

M13 Borg G. Med Sci Sports Exerc. 1982;14:377–81.

M14 Ware JE, et aI Med Care. 1992;30:473–83.

M15 Ware JE, et aI Med Care. 1996;34:220–33.

M16 Collin C, et al Int Disabil Stud. 1988;10:64–7.

M17 Hays RD, et al Health Econ. 1993;2:217–27.

M18 Nelson E, et al JAMA. 1983;249:3331–8.

MI9 Radosevich DM, et aI Health Status Questionnaire (HSQ) 2.0. Bloomington, Minn;Health Outcomes Institute, 1994.

M20 Borg G. Med Sci Sports Exerc. 1982;14:377–81.

M21 Singh SJ, et aI Thorax. 1992;47:1019–24.

M22 Zigmond AS, et al Acta Psychiatr Scan. 1983;67–6):361–70.

M23 Goldberg DP, et al Psychol Med. 1979;9:139–45.

M24 Radloff LS. Appl Psychol Meas. 1977;1:385–401.

M25 Jones P, et al Am Rev Respir Dis. 1992;145:1321–7.

M26 Portenoy RK, et al Eur J Cancer. 1994;30A: 1326–36.

M27 Wijnhoven HA, et al Chest. 2001;119:1034–42.

M28 Bradburn N. The structure of psychological well-being. Chicago:Aldine, 1969.

M29 MailleAR, et al Respir Med. 1997;91:297–309.

M30 Kaplan RM et al J Chron Dis. 1984;37:85–95.

M31 The EuroQol Group. Health Policy. 1990;16:199–208.

Table 4 Relative risks of hospitalization and emergency department (ED)/unscheduled visits for intervention patients versus control patients

Source	Study setting	Included GOLD-stages	Number of components	Relative risk of hospitalization (95% Confidence interval)	Relative risk of EDI unscheduled visits (95% Confidence interval)
Bourbeau et al (2003)^Citation32	Secondary care	2 and 3	3	0.64 (0.45–0.91)	0.64 (0.48–0.86)
Casas et al (2006)^Citation38	Tertiary care	3 and 4	4	0.67 (0.49–0.91)	NA
Gourley et al (1998)^Citation24	Secondary care	3 and 4	2	NA	1.12 (0.44–5.43)
Hermiz et al (2002)^Citation27	Community and primary care	2 and 3	2	1.27 (0.66–2.43)	0.28 (0.06–1.27)
Hernandez et al (2003)^Citation37	Secondary and tertiary care	2 and 3	2	0.74 (0.45–1.21)	0.44 (0.22–0.86)
Jeffs et al (2005)^Citation28	Secondary care	1–4	2	1.50 (0.84–2.67)	NA
Poole et al (2001)^Citation30	Secondary care	3	2	1.08 (0.75–1.57)	NA
Rea et al (2004)^Citation31	Primary care	2 and 3	4	0.81 (0.59–0.83)	0.46 (0.16–1.37)
Smith et al (1999)^Citation29	Secondary care	3	2	1.01 (0.82–1.26)	2.28 (0.96–5.43)

Table 5 Relative risks of mortality for intervention patients versus control patients

Source	Study setting	Included GOLD-stages	Number of components	Relative risk (95% Confidence interval)
Aiken et al (2006)^Citation20	Tertiary care	3 and 4	3	1.20 (0.60–2.40)
Bourbeau et al (2003)^Citation32	Secondary care	2 and 3	3	0.56 (0.19–1.60)
Casas et al (2006)^Citation38	Tertiary care	3 and 4	4	1.19 (0.59–2.39)
Coultas et al (2005)^Citation21	Primary care	2 and 3	4	1.01 (0.21–4.86)*
Gadoury et al (2005)^Citation33	Secondary care	2 and 3	3	0.71 (0.37–1.38)
Hermiz et al (2002)^Citation27	Community and primary care	2 and 3	2	1.00 (0.43–2.33)
Hernandez et al (2003)^Citation37	Secondary and tertiary care	2 and 3	2	0.60 (0.20–1.82)
Poole et al (2001)^Citation30	Secondary care	3	2	0.33 (0.04–2.87)
Rea et al (2004)^Citation31	Primary care	2 and 3	4	0.31 (0.26–1.65)
Ries et al (2003)22	Tertiary care	3	2	0.98 (0.43–2.22)
Smith et al (1999)^Citation29	Secondary care	3	2	1.14 (0.45–2.90)

* Note: RR for case management versus usual care.

AikenLSButnerJLockhartCAOutcome evaluation of a randomized trial of the PhoenixCare Intervention: program of case management and coordinated care for the seriously chronically illJ Palliative Med20069111126

 Web of Science ®Google Scholar

BourbeauJJulienMMaltaisFReduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management interventionArch Intern Med200316358559112622605

 PubMed Web of Science ®Google Scholar

BourbeauJColletJPSchwartzmanKEconomic benefits of self-management education in COPDChest20061301704171117166985

 PubMed Web of Science ®Google Scholar

GadouryMASchwartzmanKRouleauMSelf-management reduces both short- and long-term hospitalisation in COPDEur Respir J20052685385716264046

 PubMed Web of Science ®Google Scholar

CasasATroostersTGarcia-AymerichJIntegrated care prevents hospitalisations for exacerbations in COPD patientsEur Respir J20062812313016611656

 PubMed Web of Science ®Google Scholar

CoultasDFrederickJBarnettBA randomized trial of two types of nurse assisted home care for patients with COPDChest20051282017202416236850

 PubMed Web of Science ®Google Scholar

EganEClavarinoABurridgeLA randomized control trial of nursing-based case management for patients with chronic obstructive pulmonary diseaseLippincott’s Case Manage20027170179

 Google Scholar

HermizOCominoEMarksGRandomised controlled trial of home care of patients with chronic obstructive pulmonary diseaseBMJ200232593894212399344

 PubMed Web of Science ®Google Scholar

HernandezCCasaAEscarrabillJHome hospitalisation of exacerbated chronic obstructive pulmonary disease patientsEur Respir J200321586712570110

 PubMed Web of Science ®Google Scholar

HesselinkAEPenninxBWJHVan der WindtDAWMEffectiveness of an education programme by a general practice assistant for asthma and COPD patients: results from a randomised controlled trialPatient Educ Couns20045512112815476999

 PubMed Web of Science ®Google Scholar

JeffsKJLimWKLimMThe effect of a post acute respiratory outreach servive for patients with chronic obstructive pulmonary disease in hospital readmission ratesRespirology20051023924315823192

 PubMed Web of Science ®Google Scholar

LeeDTFLeeIFKMackenzieAEEffects of a care protocol on care outcomes in older nursing home patients with chronic obstructive pulmonary diseaseJ Am Geriatr Soc20025087088612028174

 PubMed Web of Science ®Google Scholar

PoolePJChaseBFrankelACase management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary diseaseRespirology20016374211264761

 PubMedGoogle Scholar

ReaHMcAuleySStewartAA chronic disease management programme can reduce days in hospital for patients with chronic obstructive pulmonary diseaseInternal Med J20043460861415546454

 PubMed Web of Science ®Google Scholar

RiesALKaplanRMMyersRMaintenance after pulmonary rehabilitation in chronic lung diseaseAm J Respir Crit Care Med200316788088812505859

 PubMed Web of Science ®Google Scholar

SmithBJAdamsRAppletonSLThe effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD)Aust NZ J Med199929718725

 PubMedGoogle Scholar

SolomonDKPortnerTSBassGEPart 2. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes studyJ Am Pharm Assoc199838574585

 Google Scholar

GourleyGAPortnerTSGourleyDRPart 3. Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes studyJ Am Pharm Assoc199838586597

 Google Scholar

SteutenLVrijhoefBVan MerodeFEvaluation of regional disease management programme for patients with asthma or chronic obstructive pulmonary diseaseInt J Quality Health Care200618429436

 Web of Science ®Google Scholar

WeinbergerMMurrayMDMarreroDGEffectiveness of pharmacist care for patients with reactive airways diseaseJAMA20022881594160212350190

 PubMed Web of Science ®Google Scholar