Effects of a structured, nurse-led follow-up program on clinical outcomes in chronic obstructive pulmonary disease patients: A randomized controlled trial

Elham Saberi  Noghabi; Fatemeh  Mohammadzadeh

doi:10.18502/npt.v13i3.22134

Elham Saberi Noghabi Department of Community Health Nursing and Nursing Management, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
Fatemeh Mohammadzadeh Department of Epidemiology & Biostatistics, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran

DOI: https://doi.org/10.18502/npt.v13i3.22134

Keywords: pulmonary disease; chronic obstructive; nurses; disease management; patient readmission; randomized controlled trial

Abstract

Background & Aim: Post-discharge follow-up is essential to prevent exacerbation in patients with COPD. This study examined the impact of a 3-month nurse-led follow-up program on early symptom worsening and severe post-discharge outcomes.

Methods & Materials: A single-center, parallel-group randomized clinical trial was conducted among 88 hospitalized COPD patients in Gonabad, Iran, in 2022. The intervention group received a structured nurse-led follow-up program for three months, including planned education, telephone-based symptom monitoring, and zone-based triage with referral when needed. The control group received usual post-discharge care without scheduled follow-up. Primary outcomes were the Modified Borg Dyspnea Scale and the COPD Assessment Test at baseline and three months. Secondary outcomes included unplanned emergency department visits, readmissions, and post-discharge physical complications. Data analysis was performed in SPSS 21.0 using the Chi-square test, Fisher’s exact test, ANCOVA, and paired t-test.

Results: Modified Borg Dyspnea Scale and COPD Assessment Test scores decreased in the intervention group from 3.31 (SD=2.32) to 2.71 (SD=2.84) and 14.91 (SD=10.91) to 12.65 (SD=11.04), respectively, while they increased in control group from 4.08 (SD=2.56) to 4.43 (SD=2.72) and 16.27 (SD=11.22) to 18.36 (SD=11.70) (adjusted p=0.002 for both outcomes. Clinically meaningful improvement was more frequent in the intervention group for both Modified Borg Dyspnea Scale (p=0.013) and CAT (p=0.007). Physical complications were lower in the intervention group (25.6% vs 48.9%; p=0.024), but emergency department visits and readmissions did not differ significantly.

Conclusion: A structured nurse-led follow-up program improved symptoms and reduced complications among patients with COPD. Its integration into transitional care is recommended to enhance recovery after hospitalization.