184 6 Chapter 6 portal and separate intervention modules and observed that use of the web portal di ered greatly among participants; some used the diary almost every day, others used it on only half of the days. Varying levels of implementation were also reported by Kennedy 2013 and Zwar 2016 . Zwar 2016 particularly reported low implementation rates by practitioners and low response to questionnaires caused by limited time. 8.2 Satisfaction Eight studies assessed patient satisfaction with the IDM programme in some way (Bernocchi 2017; Fan 2012; Ko 2009; Kruis 2014; Littlejohns 1991; Rose 2017; Tabak 2014; Zwar 2016). Various questionnaires, either validated or self-developed, were used to measure patient satisfaction; this made pooling impossible. Rose 2017 and Tabak 2014 used the eight-item Client Satisfaction Questionnaire (CSQ-8) (Attkisson 2004). Tabak 2014 measured lower satisfaction with the telehealth programme compared to usual care, and Rose 2017 found no di erences between groups. Likewise, Fan 2012 found no di erences between groups on the 21-item Seattle Outpatient Satisfaction Questionnaire, and Littlejohns 1991 found no di erences on its self-developed questionnaire. Both Bernocchi 2017 and Ko 2009 reported high satisfaction scores for IDM, except for use of the pedometer, but did not compare satisfaction scores with those of the control group. Bernocchi 2017 saw that patients reported high satisfaction on all items of the self-developed questionnaire, including service as a whole, use of the devices, and healthcare professionals’ willingness to respond to patient needs. Zwar 2016 included patient satisfaction as a secondary outcome in its protocol paper but for unknown reasons did not report on this. 8.3 Co-ordination of care Two studies assessed co-ordination of care (Kruis 2014; Zwar 2016). Kruis 2014 measured the level of care integration from the view of patients using the Patient Assessment Chronic Illness Care (PACIC) and found a statistically signi cant increase and di erence in favour of the IDM group (Glasgow 2005). Zwar 2016 included in its protocol the Collaborative Practice Scale to assess ‘interactions between nurses and GPs that enable synergistic in uence of patient care’ (WEISS 1985). For unknown reasons, these results were not reported. Discussion Summary of main results This review summarised and meta-analysed the results of 52 studies involving 21,086 participants with chronic obstructive pulmonary disease (COPD) who were randomly allocated to usual care or to an integrated disease management (IDM) programme with a minimum duration of 12 weeks. This review is an update of the review performed in 2013 (Kruis 2013). Studies were conducted in 19 di erent countries across multiple healthcare settings. All studies investigated an IDM programme. Studies di ered in terms of intervention components, duration of intervention, healthcare professional
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