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General practitioners were recruited from the western part of the Netherlands.Patients in both groups received an information leaflet stating that the aim of the study was to improve treatment of COPD in primary care and that general practitioners were randomised to two groups.After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain.Conclusion In this pragmatic study, an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of integrated care and a self reported higher degree of daily activities.The intervention was delivered at the cluster level.General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice.From styling and dyeing to proper hair care: Here you will find everything you need for beautiful hair!Helpful tips and tricks for daily hairstyling, step-by-step instructions for glamorous styles and of course professional colour consulting to ensure your favourite hair colour also turns out perfectly at home!
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As COPD is a disease with increasing prevalence, and general practitioners and family physicians treat most patients, well designed studies of pragmatic integrated disease management programmes in primary care are essential.
However, in COPD trials, the participants commonly comprise a small and selected fraction of the real world population, resulting in leading medical journals calling for studies in more representative patient populations.6 7 The few studies of integrated disease management in primary care recruited patients in secondary care,8 9 10 11 consisted of palliative programmes for severe patients,12 13 had a short duration of intervention,9 10 11 12 14 or did not correct for cluster analysis.15 The true effect of integrated disease management in primary care thus remains inconclusive.
Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group.
No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8).
Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence.