Objective Studies in hospital settings demonstrate that there is greater guideline adherence when care is delivered by a respiratory specialist, however, this has not been explored in primary care. The aim of this study is to determine the impact integrating respiratory specialists into primary care has on the delivery of guideline adherent chronic obstructive pulmonary disease (COPD) care. Methods 18 general practitioner (GP) practices were randomised to provide either usual or specialist-led COPD care. Patients at participating practices were included if they had an existing diagnosis of COPD. Outcomes were measured at the individual patient level. The primary outcome was guideline adherence, assessed as achieving four or more items of the COPD care bundle. Secondary outcome measures included quality of life, number of exacerbations, number of COPD-related hospitalisations and respiratory outpatient attendances. Results 586 patients from 10 practices randomised to the intervention and 656 patients from 8 practices randomised to the control arm of the study were included. The integration of respiratory specialists into GP practices led to a statistically significant (p<0.001) improvement in the provision of guideline adherent care when compared with usual care in this cohort (92.7% vs 70.1%) (OR 4.14, 95% CI 2.14 to 8.03). Conclusion This is the first study to demonstrate that guideline adherence is improved through the integration of respiratory specialists into GP practices to deliver annual COPD reviews. To facilitate changes in current healthcare practice and policy, the findings of this paper need to be viewed in combination with qualitative research exploring the acceptability of specialist integration. Trial registration number [NCT03482700][1]. Data are available on reasonable request. Anonymised study data will be made available on reasonable request to the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03482700&atom=%2Fthoraxjnl%2F79%2F3%2F209.atom

中文翻译：

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专家主导的慢性阻塞性肺病综合护理的整群随机对照试验 (INTEGR COPD)

目的 在医院环境中进行的研究表明，由呼吸科专家提供护理时，可以更好地遵守指南，但是，初级保健中尚未对此进行探索。本研究的目的是确定将呼吸科专家纳入初级保健对提供遵循指南的慢性阻塞性肺疾病 (COPD) 护理的影响。方法 18 家全科医生 (GP) 诊所被随机分配以提供常规或专家主导的 COPD 护理。如果参与实践的患者已被诊断为慢性阻塞性肺病，则该患者也被纳入其中。结果是在个体患者水平上进行测量的。主要结局是指南的遵守情况，评估为实现慢性阻塞性肺病护理包中的四个或更多项目。次要结果指标包括生活质量、病情加重次数、慢性阻塞性肺病相关住院次数和呼吸系统门诊就诊次数。结果 来自 10 个诊所的 586 名患者被随机分配到干预组，来自 8 个诊所的 656 名患者被随机分配到研究的对照组。与该队列中的常规护理相比，呼吸科专家融入全科医生实践中，在提供指南依从护理方面取得了统计学上显着的改善（p<0.001）（92.7% vs 70.1%）（OR 4.14，95% CI 2.14 8.03）。结论 这是第一项研究，证明通过将呼吸科专家纳入全科医生实践中进行年度慢性阻塞性肺病 (COPD) 审查，可以提高指南的依从性。为了促进当前医疗保健实践和政策的变化，需要结合探索专家整合可接受性的定性研究来看待本文的研究结果。试用注册号[NCT03482700][1]。可根据合理要求提供数据。匿名研究数据将根据相应作者的合理要求提供。 [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03482700&atom=%2Fthoraxjnl%2F79%2F3%2F209.atom