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Background: Comprehensive COPD care is complex and shortcomings in quality are common in primary care. Objectives: To test whether a multifaceted intervention delivered to general practitioners (GPs) and their practice assistants’ increases implementation of recommended COPD care. Methods: Cluster- randomized trial on GP-level. The intervention was designed to governing evidence-based decision making and behaviour supported by a “Primary care COPD care bundle”. Data was collected using questionnaires at GP and patient level at baseline and one year after the intervention. The primary outcome was the composite score of implemented care elements measured at the patient level. Results: Thirty-five GPs and 216 patients median age 69 years, 59% female, 69% GOLD stadium A or B were enrolled, 161 patients completed follow-up. After one year the composite score of implemented care increased from 4.7 to 6.1 (+1.4) in the intervention group and decreased from 5.3 to 4.4 (-0.9) in the control group. Linear regression model adjusting for baseline characteristics revealed a between-group difference of +2.0 (95% CI +1.2 to +2.8) implemented processes in favour of the intervention group. . The intervention increased implementation in 9 out of 15 processes (figure). Conclusion: Coaching of primary care teams including a COPD care bundle helped transferring knowledge to clinical practice and resulted in improved COPD care .

Background/Aim: Pivotal objectives of self-management programs are behavior change, coping and better health related quality of life (HRQL). The effects of the “Living well with COPD” (LWWCOPD) self-management program and usual care on coping, HRQL, smoking cessation and exacerbation frequency at 24 months were compared in COPD patients from primary care. Method: Prospective non-randomized controlled study with COPD patients who participated in the “LWWCOPD” program adapted to primary care in Switzerland. COPD patients from the primary care-based COPD Cohort ICE COLD ERIC(http://www.ClinicalTrials.govNCT00706602) served as control. The primary outcome was coping measured by the mastery domain of the Chronic Respiratory Questionnaire (CRQ). We performed multivariate regression analyses where we accounted for the lack of randomization with propensity scores. Results: 71 patients were in the self- management and 385 in the usual care cohort. Patients with the self-management program had significantly higher mastery scores (0.71(95% CI 0.28-1.13)), significantly less moderate to severe exacerbations (incidence rate ratio 0.68(95% CI 0.48-0.97)) and significantly more patients quit smoking (odds ratio 0.26 (95% CI 0.07-0.95). There was an effect on fatigue (0.75(95% CI 0.28-1.22)) whereas the effect just did not reach statistical significance for dyspnea (0.50, 95% CI -0.03-1.03) and emotional function (0.40, 95% CI -0.03-0.82, all CRQ). Conclusion: The LWWCOPD intervention in a primary care setting showed long-term benefits on coping, exacerbations and smoking cessation behavior.