Optimizing COPD care in primary care: 'going for Silver or for Gold'

Rationale:

Smoking cessation is the cornerstone of COPD treatment since it reduces the decline in pulmonary function. However, this intervention is barely implemented in everyday practice. To obtain maximum profit of COPD care, motivated patients should be offered ‘result-focused’ care, in which treatment goals are signed up in a doctor-patient contract, instead of the current ‘effort-focused’ care. ‘Result-focused’ behavioural interventions are already applied successfully in rehabilitation programs, psychiatric treatments and addiction care.



Objective:

To evaluate a ‘result-focused’ smoking-cessation-program (‘Golden care’) in which treatment goals are signed up in a doctor-patient contract.



Study design:

A two-arm, cluster randomised controlled trial, with general practice as unit of randomization.



Study population:

720 smoking COPD patients



Intervention:

All patients of the intervention group receive ‘Silver care’. When
motivated to initiate a quit attempt, treatment goals are composed in a doctor-patient contract and the patient attends an intense smoking-cessation-program (‘Golden care’). After 6, 12 and 24 months goals will be evaluated. Noncompliant patients will again receive ‘Silver care’ for at least three months to get motivated for smoking cessation once more. Patients unmotivated to quit smoking will continuously receive ‘Silver care’.



Main endpoints:

Primary endpoint: point prevalence after 24 months, measured by self-reported smoking and urinary cotinine measurement.
Secondary endpoint: smoking abstinence, functional status, motivation for smoking cessation, illness perception, quality of life, social stimulation, self-efficacy, smoking habits and pulmonary function.



Statistical analysis:

Intention-to-treat analysis. Primary outcome is measured by logistic regression analysis. Differences in secondary outcome measures are measured by co-variation analysis.

The objective of this study is to evaluate a ‘result oriented’ smoking cessation program (‘Silver or Gold’) for COPD patients in which treatment goals are signed up in a doctor-patient contract.

Baseline, 1 year, 2 years

Intervention group:

All patients of the intervention group receive ‘Silver care’. When
motivated to initiate a quit attempt, treatment goals are composed in a doctor-patient contract and the patient attends an intense smoking-cessation-program (‘Golden care’). After 6, 12 and 24 months goals will be evaluated. Noncompliant patients will again receive ‘Silver care’ for at least three months to get motivated for smoking cessation once more. Patients unmotivated to quit smoking will continuously receive ‘Silver care’.



Control group:

Patients in the control group receive care as usual