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Transfer of care for outpatients with stable chronic obstructive pulmonary disease from respiratory care physician to respiratory nurse — a randomized controlled study

University Maastricht, Faculty of Health, Medicine & Life Sciences, Department of Health Care Studies, PO Box 616, 6200 MD Maastricht, The Netherlandsb.vrijhoef{at}zw.unimaas.nl, University Hospital Maastricht, Department of Integrated Care, PO Box 5800, 6202 AZ Maastricht, The Netherlands

J.H.A.M. Van Den Bergh

Medical Centre Alkmaar, Department of Pulmonology, PO Box 501, 1800 AM Alkmaar, The Netherlands

J.P.M. Diederiks

University Maastricht, Faculty of Health, Medicine & Life Sciences, Department of Health Care Studies, PO Box 616, 6200 MD Maastricht, The Netherlands

I. Weemhoff

Medical Centre Alkmaar, Department of Pulmonology, PO Box 501, 1800 AM Alkmaar, The Netherlands

C. Spreeuwenberg

University Maastricht, Faculty of Health, Medicine & Life Sciences, Department of Health Care Studies, PO Box 616, 6200 MD Maastricht, The Netherlands, University Hospital Maastricht, Department of Integrated Care, PO Box 5800, 6202 AZ Maastricht, The Netherlands

Objectives: To assess effects on patient outcomes when care for patients with stable chronic obstructive pulmonary disease (COPD) is transferred from respiratory care physician to respiratory nurse.

Methods: A randomized controlled trial was used with a follow-up period of 9 months. Of 720 patients from the respiratory outpatient clinic of the general and teaching hospital in Alkmaar (The Netherlands), 187 were eligible for randomization and gave informed consent. Ninety-three patients received care from the nurse, and 87 received usual care. Outcomes measured were: clinical parameters, health status, self-care behaviour (including knowledge), patient satisfaction, and consultations with key care providers.

Results: The respiratory nurse reported more consultations than the respiratory care physician [mean (standard deviation)]: number of consultations 3.1 (0.7) by nurse and 2.0 (0.9) by physician (p = 0.007). Patients cared for by the nurse showed worsening in mean forced vital capacity [—5.5% (13.3%) v. +2.9% (18.2%) with physician; p = 0.004], and no difference in self-assessed condition, while improvements were found for subjective knowledge (p = 0.017), self-assessed rate for coping with COPD (p = 0.045), overall satisfaction (p = 0.003), and the majority of individual indicators of satisfaction. Groups showed no differences for forced expiratory volume in 1 s, body mass index, smoking status, health status, objective knowledge, other items of self-care behaviour, and consultations with key care providers.

Discussion: Assignment of care for outpatients with stable COPD to the respiratory nurse, working under a protocol, seems to be justified in terms of patient outcomes.

Key Words: COPD • RCT • Respiratory care physician • Respiratory nurse • Substitution

Chronic Illness, Vol. 3, No. 2, 130-144 (2007)
DOI: 10.1177/1742395307081733


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