Abstract
BACKGROUND: In the region of Maastricht a disease management model for patients with asthma or Chronic Obstructive Pulmonary Disease (COPD) was designed. By integrating care the model aims to continuously improve the process of care delivery. Based on the intensity of care required all patients are assigned to one member of a team of care providers: general practitioner, respiratory nurse, or pulmonologist. AIM: Before implementation of the model a pilot study was performed to assess the feasibility of establishing a working diagnosis and assigning patients both with a central role for the respiratory nurse. METHOD: Following a well defined procedure, respiratory nurses evaluated the respiratory symptoms and lung function, including the reversibility of the airflow obstruction, of patients ( 18 yrs) submitted by their general practitioner. This procedure took place in primary care. Diagnosis, definition of severity of asthma or COPD, and assignment to one of the three primary responsible care providers was established by the team based on national guidelines. RESULTS: During a period of six weeks, 247 patients were submitted by 3 general practitioners. Of patients 47% were male, aged 49.6∓14.7 yrs, and FEV(1) (%pred) of 87.0∓23.5%. Asthma was diagnosed in 54.7% of patients (25.1% intermittent, 13.8% mild, 14.2% moderate, 1.6% severe persistent). COPD was diagnosed in 21.1% (6.9% mild, 8.9% moderate, 5.3% severe). In 24.3% of patients neither asthma nor COPD was diagnosed. For further provision of care 40.0% of patients were allocated to the nurse, 4.5% to the pulmonologist, and 55.5% were referred back to the general practitioner. CONCLUSION: The team approach to diagnose patients with asthma or COPD as well as to assign patients for further management was found feasible. Further study is needed to assess the effectiveness of the disease management model once patients are assigned to one of the primary responsible care providers.