1 Liang J, et al. BMJ Open 2017;7:e016985. doi:10.1136/bmjopen-2017-016985 Open Access Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial Jenifer Liang, 1 Michael J Abramson, 2 Nicholas Zwar, 3,4 Grant Russell, 5 Anne E Holland, 6,7,8 Billie Bonevski, 9 Ajay Mahal, 2,10 Benjamin van Hecke, 11 Kirsten Phillips, 12 Paula Eustace, 13 Eldho Paul, 2,14 Kate Petrie, 1 Sally Wilson, 1 Johnson George 1 To cite: Liang J, Abramson MJ, Zwar N, et al. Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial. BMJ Open 2017;7:e016985. doi:10.1136/ bmjopen-2017-016985 ► Prepublication history for this paper is available online. To view these fles please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2017- 016985). Received 30 March 2017 Revised 30 June 2017 Accepted 5 July 2017 For numbered affliations see end of article. Correspondence to Dr Johnson George; johnson.george@monash.edu Protocol ABSTRACT Introduction Up to half of all smokers develop clinically signifcant chronic obstructive pulmonary disease (COPD). Gaps exist in the implementation and uptake of evidence- based guidelines for managing COPD in primary care. We describe the methodology of a cluster randomised controlled trial (cRCT) evaluating the effcacy and cost- effectiveness of an interdisciplinary model of care aimed at reducing the burden of smoking and COPD in Australian primary care settings. Methods and analysis A cRCT is being undertaken to evaluate an interdisciplinary model of care (RADICALS — Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers). General practice clinics across Melbourne, Australia, are identifed and randomised to the intervention group (RADICALS) or usual care. Patients who are current or ex-smokers, of at least 10 pack years, including those with an existing diagnosis of COPD, are being recruited to identify 280 participants with a spirometry-confrmed diagnosis of COPD. Handheld lung function devices are being used to facilitate case-fnding. RADICALS includes individualised smoking cessation support, home-based pulmonary rehabilitation and home medicines review. Patients at control group sites receive usual care and Quitline referral, as appropriate. Follow-ups occur at 6 and 12 months from baseline to assess changes in quality of life, abstinence rates, health resource utilisation, symptom severity and lung function. The primary outcome is change in St George’s Respiratory Questionnaire score of patients with COPD at 6 months from baseline. Ethics and dissemination This project has been approved by the Monash University Human Research Ethics Committee and La Trobe University Human Ethics Committee (CF14/1018 – 2014000433). Results of the study will be disseminated in peer-reviewed journals and research conferences. If the intervention is successful, the RADICALS programme could potentially be integrated into general practices across Australia and sustained over time. Trial registration number ACTRN12614001155684; Pre- results. INTRODUCTION Chronic obstructive pulmonary disease (COPD) (COPD) is a major public health problem. Symptoms and compli- cations of the condition can greatly affect patients’ ability to undertake daily activities, impair quality of life and result in exten- sive use of health services. According to the World Health Organisation (WHO), COPD is the fourth leading cause of death and is projected to be the third leading cause of death by 2030 (potentially contributing to 8.6% of deaths worldwide). 1 In Australia, the overall prevalence of moderate to severe COPD in adults aged 40 years and over is 7.5% (95% CI 5.7% to 9.4%). 2 3 The preva- lence increases to 29.2% (95% CI 18.1% to 40.2%) among those aged 75 years and over. 3 In 2012, 4% of all deaths among Australians Strengths and limitations of this study ► A large implementation trial in primary care involving current smokers, ex-smokers and patients with an existing diagnosis of chronic obstructive pulmonary disease. ► Cluster randomisation of general practices to minimise the risk of contamination, and blinded outcome assessment. ► Open-labelled trial; participants and health professionals are not blinded, with a potential for Hawthorne effect.