Favorable results from a Dutch asthma/COPD service for primary care

Introduction:In 2007, an asthma/COPD(AC) service was implemented in The North of the Netherlands to advice general practitioner(GP)s in diagnosing and treating their asthma and COPD patients by involving local pulmonologists. GPs may refer patients for single/yearly follow up assessments. If so, patients are automatically scheduled for an additional 3 months assessment if a change in medication is advised by the pulmonologist. At the moment, ∼12.000 baseline and ∼1000 follow up visits are performed.
Aim:To examine longitudinal data on disease related outcomes 
Methods:Spirometry, medical history, health status (Clinical COPD Questionnaire (CCQ)) and asthma control (Asthma Control Questionnaire (ACQ)) were assessed by the service. Non parametric tests were used for the evaluation of exacerbations and ACQ/CCQ scores between baseline and follow up. 
Results:The proportion of patients with ≥1 exacerbation/year decreased from 37% at baseline to 26% at 12 months (n=1062, p<0.000). In COPD patients scheduled for the 3 months follow up, the proportion of stable COPD patients (CCQ<1) increased from 37% (baseline) to 51% (3 months, n=149 p=0.001). In asthma patients the proportion of patients with well controlled asthma (ACQ <0.75) increased from 24% (baseline) to 49% (3 months, n=504 p<0.000).
Conclusion:Patients in the AC service improved on exacerbation/year. If change in medication was advised, COPD patients improved on health status and asthma patients improved on asthma control. Asthma and COPD patients referred to 12 months follow up stabilized in health status and asthma control. More research is needed to elucidate which factors contribute to the improvement.