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Eur Respir J. 2018 May 10;51(5). pii: 1701873. doi: 10.1183/13993003.01873-2017. Print 2018 May.

Care in Chronic Obstructive Lung Disease (CAROL): a randomised trial in general practice.

Author information

Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.


Disease management of chronic obstructive pulmonary disease (COPD) is complex and shortcomings in general practice care for COPD are common. A care bundle is a disease management aid used as a reminder and for steering specific elements of care. Our objectives were to test whether a COPD care bundle delivered to general practitioners (GPs) and practice assistants increases the implementation of key elements of COPD care.The study was a cluster-randomised clinical trial, with 1:1 randomisation of GPs and a 1-year follow-up. The intervention introduced a COPD care bundle and aimed at enhancing collaboration between GPs and practice assistants. The control group continued usual care. The primary outcome measure was the composite score from nine key elements of COPD care measured at the patient level.We enrolled 35 GPs and 216 patients with a median age of 69 years, 59% female, 69% Global Initiative for Chronic Obstructive Lung Disease group A or B. After 1 year, the between-group difference in change of the primary outcome measure was +2.2 (95% CI +1.5- +2.9) in favour of the intervention group. The intervention was associated with significantly higher implementation rates in seven out of nine key elements of care.Disease management using a COPD care bundle increased the implementation of key elements of COPD care in general practice.

Conflict of interest statement

Conflict of interest: S. Markun, T. Rosemann, K. Dalla-Lana and C. Steurer-Stey report receiving grants from AstraZeneca Schweiz, Boehringer Ingelheim Switzerland, the Dept of Health of the Canton of Zurich, the Swiss Federal Office of Public Health (BAG) and Novartis Schweiz, during the conduct of the study.

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