Patients suffering from chronic obstructive pulmonary disease (COPD) are currently treated based on pulmonary function measurements. However, although pulmonary function determines the gravity of the disease, it bears little relation to the number of complaints experienced by COPD patients. According to research by UMCG PhD candidate Janwillem Kocks, measuring these complaints and patients’ health status with a questionnaire proves useful in guiding COPD treatment in daily practice. The questionnaire is also able to accurately predict how the disease will develop during a hospital stay. Kocks will be awarded a PhD by the University of Groningen on 1 June 2011.
Taken together, the number of complaints and their impact on daily life are known as health status. To determine health status in the event of COPD, questionnaires have been developed and validated. De Clinical COPD Questionnaire (CCQ) comprises 10 questions in three categories: complaints, functional status (what patients are capable of and what they do in practice) and mental status (how they feel about this). Until now, questionnaires were more often used for scientific research purposes than to treat individual patients. Kocks investigated the conditions and possibilities of guiding COPD treatment based on the CCQ, rather than solely on pulmonary function.
The quality required for a questionnaire used to treat individual patients is higher than the quality necessary for one used to measure matters in patient groups. In his research, Kocks studied the reliability of the CCQ when used in treatment at an individual level. To do so, he compared the questionnaire scores of patients and doctors. Patients completed the questionnaire before visiting their lung specialist. After the consultation, the specialist completed the questionnaire about the patient in the manner he or she thought the patient should have filled it in. The patients were then interviewed in depth and the information this yielded was given to a number of lung specialists and GPs to use in completing the questionnaire. All of the physicians’ judgments were compared to the patients’, and this showed that the scores matched well. Kocks concluded that the CCQ can be used as a reliable tool for individual patients in daily practice. The Netherlands appears to be leading the way in using the concept of health status – or the burden of disease – to guide the treatment of COPD.
The use of the CCQ during a hospital stay due to an acute case of COPD exacerbation was also investigated. The health status as measured by the CCQ proved able to predict how quickly patients would need to be put on intensive care, would need to be readmitted after being discharged or would die. This differs greatly from often used measurements such as blood oxygen levels or the degree of shortness of breath experienced, which cannot properly predict the course of disease in this group of patients. Kocks found that practitioners were able to glean lots of additional and valuable information from the CCQ when patients were experiencing COPD exacerbation.
Janwillem Kocks (Zwolle, 1980) studied medicine at the University of Groningen and then specialized as a general practitioner (GP). While training as a GP, he conducted his PhD research at the UMCG’s General Practice Medicine department and its Groningen Research Institute for Asthma and COPD (GRIAC). Kocks’s thesis is entitled ‘Towards health status guided care in COPD using the Clinical COPD Questionnaire’. Supervisors: T. van der Molen, H.A.M. Kerstjens. Kocks will continue to work as a GP with the Academische Huisartsenpraktijk Groningen (Groningen Academic GP post) and as a researcher at the General Practice Medicine department at the UMCG.
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