"Consultation Liaison and Integrated Care for COPD Patients With Psychiatric Co-Morbidity"

NCT01644916 | Completed DMC

• 1 other identifier: COPD_HSRG_2010
• Study Type: interventional
• Target: 295
• Locations: 1 country
• Sites: 1

Brief Summary

Chronic obstructive pulmonary disease (COPD) stands out among chronic diseases with its high and rising prevalence and mortality, poor quality of life, high re-hospitalization rates and societal burden of care. Current therapeutic and management practices are generally met with limited success. Research in recent years have highlighted the high level of psychiatric co-morbidity in COPD patients, and the major prognostic significance of anxiety/depression in COPD outcomes such as re-hospitalization, smoking cessation, quality of life, and survival. This suggests that addressing psychiatric and psycho-social aspects of care prominent in COPD patients may have strongly positive impact on outcomes, but the available evidence of effectiveness is limited. The primary aim of the proposed research is to evaluate the effectiveness of a holistic disease management paradigm of psychiatric liaison consultation (CL) that integrates psychiatric and respiratory care to improve outcomes for COPD patients. This integrated psychiatric consultation liaison (IPCL) management paradigm includes the routine screening and structured collaborative care of anxiety and major depressive symptoms and depressive/anxiety disorder in COPD patients. We postulate that the IPCL care paradigm would reduce mood symptoms, increase smoking quit rates, reduce symptom burden and functional disability, and improve quality of life, while reducing rehospitalization, emergency department (ED) and unscheduled physician visits. A secondary aim is to evaluate its cost effectiveness by concurrently collecting resource utilization data.

Conditions

Chronic Obstructive Pulmonary Disease; Anxiety; Depression

Keywords

COPD; Integrated care; IPCL

Outcome Measures

Primary Outcomes (1)

• HADS score

  Anxiety and depression symptoms and diagnosis

  over 12 months

Secondary Outcomes (1)

• Resource use and direct costs of care

  over 12 months

Study Arms (2)

Usual control

OTHER

Usual control will be provided with usual standard management of COPD and psychiatric comorbidities.

Procedure: Usual control

Integrated care

OTHER

Integrated care will be provided with integrated care management.

Procedure: Integrated care

Interventions

Integrated care PROCEDURE

Integrated care will be provided with management of multifaceted group including, nurse educators, doctors, case manager and psychologists.

Also known as: IPCL

Integrated care

Usual control PROCEDURE

Usual control group will be provided with usual standard procedures for management of COPD and psychiatric comorbidities.

Usual control

Eligibility Criteria

• Age: 55 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Inpatients and specialist outpatients from: NUHS, SGH, CGH, SLH and AH.
• Clinical diagnosis of chronic obstructive pulmonary disease (COPD) based on history, physical examination, spirometry, measurement of arterial blood gases, and chest radiographs, that meets the criteria for COPD as defined in the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
• COPD patients include cases of all grades of severity, and co-morbidity, without restriction.
• Participants provide written informed consent.

You may not qualify if:

• Known diagnosis of a psychiatric disorder that is under treatment.
• Terminally ill COPD patients who are unable to complete baseline assessments.

Sponsors & Collaborators

• National University of Singapore: lead
• National University Hospital, Singapore: collaborator
• Singapore General Hospital: collaborator
• Alexandra Hospital: collaborator
• St Luke's Hospital, Singapore: collaborator
• Changi General Hospital: collaborator

Study Sites (1)

National University Hospital System

Singapore, 119228, Singapore

Location

Related Publications (5)

• Ng TP, Niti M, Tan WC. Trends and ethnic differences in COPD hospitalization and mortality in Singapore. COPD. 2004 Apr;1(1):5-11. doi: 10.1081/COPD-120028702.

  PMID: 16997734 BACKGROUND

• Niti M, Ng TP, Kua EH, Ho RC, Tan CH. Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status. Int J Geriatr Psychiatry. 2007 Nov;22(11):1087-94. doi: 10.1002/gps.1789.

  PMID: 17407107 BACKGROUND

• Ng TP, Niti M, Fones C, Yap KB, Tan WC. Co-morbid association of depression and COPD: a population-based study. Respir Med. 2009 Jun;103(6):895-901. doi: 10.1016/j.rmed.2008.12.010. Epub 2009 Jan 10.

  PMID: 19136238 BACKGROUND

• Cao Z, Ong KC, Eng P, Tan WC, Ng TP. Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology. 2006 Mar;11(2):188-95. doi: 10.1111/j.1440-1843.2006.00819.x.

  PMID: 16548905 BACKGROUND

• Ng TP, Niti M, Tan WC, Cao Z, Ong KC, Eng P. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med. 2007 Jan 8;167(1):60-7. doi: 10.1001/archinte.167.1.60.

  PMID: 17210879 BACKGROUND

Related Links

• department of psychological medicine, gerontological research programme

MeSH Terms

Conditions

Pulmonary Disease, Chronic Obstructive; Anxiety Disorders; Depression

Interventions

Delivery of Health Care, Integrated

Condition Hierarchy (Ancestors)

Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Mental Disorders; Behavioral Symptoms; Behavior

Intervention Hierarchy (Ancestors)

Delivery of Health Care; Patient Care Management; Health Services Administration; Health Care Quality, Access, and Evaluation

Study Officials

• Ng T Pin, MD

  National University of Singapore

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Director

Study Record Dates

• First Submitted: July 17, 2012
• First Posted: July 19, 2012
• Study Start: August 1, 2012
• Primary Completion: December 1, 2017
• Study Completion: December 1, 2017
• Last Updated: September 7, 2018

Record last verified: 2018-09

Locations

SG (1)