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Post hospitalization management of patients with COPD. Nurs Manag (Harrow) 2017; 49:14-21. [PMID: 29287045 DOI: 10.1097/01.numa.0000527713.06404.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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102
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Allinson JP, Wedzicha JA. Update in Chronic Obstructive Pulmonary Disease 2016. Am J Respir Crit Care Med 2017; 196:414-424. [PMID: 28570121 DOI: 10.1164/rccm.201703-0588up] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James P Allinson
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Shannon R, Donovan-Hall M, Bruton A. Motivational interviewing in respiratory therapy: What do clinicians need to make it part of routine care? A qualitative study. PLoS One 2017; 12:e0187335. [PMID: 29088308 PMCID: PMC5663487 DOI: 10.1371/journal.pone.0187335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Motivational interviewing (MI) is a method for building motivation for behaviour change that has potential for use in respiratory contexts. There is a paucity of published research exploring the feasibility of this intervention from the clinicians’ perspective. This study aimed to explore respiratory clinicians' views of MI: Is it perceived as useful? Could it be integrated into practice? What training would be required to make it part of routine care? Nine respiratory clinicians attended a one-day MI workshop and a semi-structured face-to-face interview two weeks later. All interviews were audio-recorded, transcribed verbatim and analysed with thematic analysis. Four main themes are presented—1) MI’s suitability for use in respiratory contexts: participants saw potential in using MI to motivate their patients to engage with prescribed respiratory interventions, such as increased physical activity. Those who experimented with new skills post-workshop were encouraged by patient responsiveness and outcomes. 2) MI’s relationship with routine clinical practice: some believed they already used elements of MI, but most participants felt MI was fundamentally 'different' to their normal style of working. 3) Implementation issues: additional time would need to be made available to enable an appropriate depth of conversation. 4) Training issues: Participants sensed the complexity of MI could make it difficult to learn and that it would take them time to become competent. On-going supervision was perceived as necessary. One key challenge identified was how to suppress behaviours that are antithetical to MI. These findings lend support to the feasibility of using MI in respiratory contexts such as pulmonary rehabilitation programmes, but highlight implementation and training issues that would need to be overcome. The insights have informed the development of another study, testing the effect of a tailored training package on MI skill, specifically for respiratory clinicians delivering pulmonary rehabilitation programmes.
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Affiliation(s)
- Robert Shannon
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Maggie Donovan-Hall
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Bruton
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
- Southampton NIHR Biomedical Research Centre, Southampton, United Kingdom
- Wessex NIHR CLAHRC, Southampton, United Kingdom
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Markun S, Franzen DP, Dalla Lana K, Beyer S, Wieser S, Hess T, Kohler M, Rosemann T, Senn O, Steurer-Stey C. Acute exacerbated COPD: room for improvement in key elements of care. Int J Chron Obstruct Pulmon Dis 2017; 12:2969-2975. [PMID: 29066878 PMCID: PMC5644547 DOI: 10.2147/copd.s145496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitalizations because of acute exacerbated COPD (AECOPD) are a major burden to patients and the health care system. Interventions during acute and post-acute hospital care exist not only to improve short-term outcomes but also to prevent future exacerbations and disease progression. We aimed at measuring the implementation rates of acute and post-acute hospital care interventions for AECOPD. Methods We performed 24 months (January 1, 2012, to December 31, 2013) retrospective medical chart review of consecutive cases hospitalized to one of three public hospitals in the canton of Zurich due to AECOPD. Implementation rates of five acute care and seven post-acute care interventions were assessed. Results Data from 263 hospitalizations (61% male, mean age 68.5 years, 47% active smokers) were analyzed. The median length of stay was 9 days (interquartile range [IQR] 6–12 days). In all, 32% of hospitalizations were caused by individuals with previous hospitalizations because of AECOPD. Implementation rates of four acute care interventions were >75% (lowest was appropriate antibiotic therapy with 56%). Compared to this, implementation rates of five post-acute care interventions were <25% (lowest was patient education and self-management advice with 2%). Conclusion The results of this audit revealed room for improvement mainly in post-acute care interventions for AECOPD.
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Affiliation(s)
| | - Daniel P Franzen
- Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich
| | | | - Swantje Beyer
- Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur
| | | | - Thomas Hess
- Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur
| | - Malcolm Kohler
- Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich
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Satori: Awakening to Outcomes That Matter: The Impact of Social Support in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2017; 14:1385-1386. [PMID: 28862500 DOI: 10.1513/annalsats.201707-526ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Rausch-Osthoff AK, Greco N, Schwank A, Beyer S, Gisi D, Scheermesser M, Meichtry A, Sievi N, Hess T, Wirz M. Effect of counselling during pulmonary rehabilitation on self-determined motivation towards physical activity in people with chronic obstructive pulmonary disease - protocol of a mixed methods study. BMC Pulm Med 2017; 17:115. [PMID: 28818057 PMCID: PMC5561562 DOI: 10.1186/s12890-017-0457-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD. METHODS A two-armed, single blind randomised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation. Patients will participate in a 12-week-rehabilitation program; individuals randomized to the interventional group will additionally participate in five counselling sessions with a physiotherapist, based on the principles of motivational interviewing. The participants' physical activity level will be measured using an accelerometer (SenseWear Pro®) before, directly and 3 months after pulmonary rehabilitation. Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity. DISCUSSION If the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation. TRIAL REGISTRATION Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
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Affiliation(s)
- Anne-Kathrin Rausch-Osthoff
- Zurich University of Applied Sciences, Institute for Physiotherapy, Technikumstrasse 71, 8401, Winterthur, Switzerland.
| | - Nicola Greco
- Kantonsspital Winterthur, Institute for Physiotherapy, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Ariane Schwank
- Kantonsspital Winterthur, Institute for Physiotherapy, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Swantje Beyer
- Kantonsspital Winterthur, Pneumology, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - David Gisi
- Kantonsspital Winterthur, Institute for Physiotherapy, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Mandy Scheermesser
- Zurich University of Applied Sciences, Institute for Physiotherapy, Technikumstrasse 71, 8401, Winterthur, Switzerland
| | - André Meichtry
- Zurich University of Applied Sciences, Institute for Physiotherapy, Technikumstrasse 71, 8401, Winterthur, Switzerland
| | - Noriane Sievi
- Zurich University Hospital, Pneumology, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Thomas Hess
- Kantonsspital Winterthur, Pneumology, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Markus Wirz
- Zurich University of Applied Sciences, Institute for Physiotherapy, Technikumstrasse 71, 8401, Winterthur, Switzerland
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Lenferink A, Brusse‐Keizer M, van der Valk PDLPM, Frith PA, Zwerink M, Monninkhof EM, van der Palen J, Effing TW. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 8:CD011682. [PMID: 28777450 PMCID: PMC6483374 DOI: 10.1002/14651858.cd011682.pub2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. OBJECTIVES To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. SELECTION CRITERIA We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary outcomes of the review were health-related quality of life (HRQoL) and number of respiratory-related hospital admissions. MAIN RESULTS We included 22 studies that involved 3,854 participants with COPD. The studies compared the effectiveness of COPD self-management interventions that included an action plan for AECOPD with usual care. The follow-up time ranged from two to 24 months and the content of the interventions was diverse.Over 12 months, there was a statistically significant beneficial effect of self-management interventions with action plans on HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score, where a lower score represents better HRQoL. We found a mean difference from usual care of -2.69 points (95% CI -4.49 to -0.90; 1,582 participants; 10 studies; high-quality evidence). Intervention participants were at a statistically significant lower risk for at least one respiratory-related hospital admission compared with participants who received usual care (OR 0.69, 95% CI 0.51 to 0.94; 3,157 participants; 14 studies; moderate-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over one year was 12 (95% CI 7 to 69) for participants with high baseline risk and 17 (95% CI 11 to 93) for participants with low baseline risk (based on the seven studies with the highest and lowest baseline risk respectively).There was no statistically significant difference in the probability of at least one all-cause hospital admission in the self-management intervention group compared to the usual care group (OR 0.74, 95% CI 0.54 to 1.03; 2467 participants; 14 studies; moderate-quality evidence). Furthermore, we observed no statistically significant difference in the number of all-cause hospitalisation days, emergency department visits, General Practitioner visits, and dyspnoea scores as measured by the (modified) Medical Research Council questionnaire for self-management intervention participants compared to usual care participants. There was no statistically significant effect observed from self-management on the number of COPD exacerbations and no difference in all-cause mortality observed (RD 0.0019, 95% CI -0.0225 to 0.0263; 3296 participants; 16 studies; moderate-quality evidence). Exploratory analysis showed a very small, but significantly higher respiratory-related mortality rate in the self-management intervention group compared to the usual care group (RD 0.028, 95% CI 0.0049 to 0.0511; 1219 participants; 7 studies; very low-quality evidence).Subgroup analyses showed significant improvements in HRQoL in self-management interventions with a smoking cessation programme (MD -4.98, 95% CI -7.17 to -2.78) compared to studies without a smoking cessation programme (MD -1.33, 95% CI -2.94 to 0.27, test for subgroup differences: Chi² = 6.89, df = 1, P = 0.009, I² = 85.5%). The number of behavioural change techniques clusters integrated in the self-management intervention, the duration of the intervention and adaptation of maintenance medication as part of the action plan did not affect HRQoL. Subgroup analyses did not detect any potential variables to explain differences in respiratory-related hospital admissions among studies. AUTHORS' CONCLUSIONS Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL, as measured with the SGRQ, and lower probability of respiratory-related hospital admissions. No excess all-cause mortality risk was observed, but exploratory analysis showed a small, but significantly higher respiratory-related mortality rate for self-management compared to usual care.For future studies, we would like to urge only using action plans together with self-management interventions that meet the requirements of the most recent COPD self-management intervention definition. To increase transparency, future study authors should provide more detailed information regarding interventions provided. This would help inform further subgroup analyses and increase the ability to provide stronger recommendations regarding effective self-management interventions that include action plans for AECOPD. For safety reasons, COPD self-management action plans should take into account comorbidities when used in the wider population of people with COPD who have comorbidities. Although we were unable to evaluate this strategy in this review, it can be expected to further increase the safety of self-management interventions. We also advise to involve Data and Safety Monitoring Boards for future COPD self-management studies.
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Affiliation(s)
- Anke Lenferink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Health Technology and Services Research, Faculty of Behavioural SciencesEnschedeNetherlands
- Flinders UniversitySchool of MedicineAdelaideAustralia
| | | | | | - Peter A Frith
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
| | - Marlies Zwerink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
| | - Evelyn M Monninkhof
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands
| | - Job van der Palen
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Research Methodology, Measurement, and Data‐Analysis, Faculty of Behavioral SciencesHaaksbergerstraat 55EnschedeNetherlands
| | - Tanja W Effing
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
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Khan A, Dickens AP, Adab P, Jordan RE. Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort. NPJ Prim Care Respir Med 2017; 27:46. [PMID: 28729620 PMCID: PMC5519687 DOI: 10.1038/s41533-017-0046-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022] Open
Abstract
Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided. CHRONIC LUNG DISEASE CALL FOR WIDER IMPLEMENTATION OF SELF-MANAGEMENT PLANS: Health professionals should ensure all patients with chronic lung disease receive individualized self-management plans and lifestyle advice. UK national guidelines state that patients with chronic obstructive pulmonary disease (COPD) should receive personalized self-management plans and comprehensive support to help them manage their disease. Ainee Khan and colleagues at the University of Birmingham analyzed patient questionnaire data gathered during the Birmingham COPD Cohort study to explore self-management behavior, receipt of self-management plans and advice, and patient knowledge of COPD. Of 1,078 participants, only 400 had self-management plans, and less than half reported receiving lifestyle advice or support. Those with plans were more likely to adhere to medication, had greater knowledge about COPD and were more likely to attend support groups and training courses. The authors recommend carefully-planned, wider implementation of COPD self-management plans and associated support.
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Affiliation(s)
- Ainee Khan
- Public Health, Solihull Metropolitan Borough Council, Solihull, B91 3QB, UK
| | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Flink M, Lindblad M, Frykholm O, Kneck Å, Nilsen P, Årestedt K, Ekstedt M. The Supporting Patient Activation in Transition to Home (sPATH) intervention: a study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure. BMJ Open 2017; 7:e014178. [PMID: 28698319 PMCID: PMC5734357 DOI: 10.1136/bmjopen-2016-014178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. METHODS/ANALYSIS The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management. ETHICS AND DISSEMINATION The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. TRIAL REGISTRATION NUMBER NCT02823795; Pre-results.
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Affiliation(s)
- Maria Flink
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Marléne Lindblad
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of technology and Health, KTH, Royal Institute of technology, Stockholm, Sweden
| | - Oscar Frykholm
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Kneck
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Faculty of Health and Life Sciences Linnaeus University, Kalmar, Sweden
- Kalmar County Hospital, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of technology and Health, KTH, Royal Institute of technology, Stockholm, Sweden
- School of Health and Caring Sciences, Faculty of Health and Life Sciences Linnaeus University, Kalmar, Sweden
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Maddocks M, Delogu V, Jones SE, Polkey MI, Man WDC. Entrenamiento físico frente a estimulación neuromuscular en la enfermedad pulmonar obstructiva crónica grave. Arch Bronconeumol 2017; 53:357-359. [DOI: 10.1016/j.arbres.2016.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
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Rehman H, Karpman C, Vickers Douglas K, Benzo RP. Effect of a Motivational Interviewing-Based Health Coaching on Quality of Life in Subjects With COPD. Respir Care 2017; 62:1043-1048. [PMID: 28611230 DOI: 10.4187/respcare.04984] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Improving quality of life (QOL) is a key goal in the care of patients with COPD. Pulmonary rehabilitation (PR) has clearly been shown to improve QOL, but is not accessible to many eligible patients. There is a need for alternative programs designed to improve patient well-being that are accessible to all patients with COPD. Our goal was to pilot test a simple, telephone-based health-coaching intervention that was recently shown to decrease readmission among hospitalized COPD patients and stable COPD patients eligible for PR. METHODS Subjects received a 3-month intervention consisting of 10 health-coaching telephone calls based on motivational interviewing principles. Outcome measures included dyspnea level, measured by the modified Medical Research Council scale, and QOL, measured by the Chronic Respiratory Questionnaire and a single-item general self-rated health status. RESULTS Fifty subjects with moderate to severe COPD were enrolled in the study. Forty-four subjects (86%) completed the study intervention. Dyspnea measured by the modified Medical Research Council score improved significantly after the intervention (P = .002). The domains of fatigue, emotional function, and mastery on the Chronic Respiratory Disease Questionnaire and the single-item QOL question also improved significantly after the 3 months of health coaching (P = .001, P = .001, P = .007, and P = .03, respectively). Thirty-six (71%) subjects had a clinically meaningful improvement in at least 1 study end point (either in the severity of dyspnea or a domain of QOL). Thirty subjects (58%) had an improvement of ≥0.5 points, the minimum clinically important difference in at least 1 component of the Chronic Respiratory Disease Questionnaire. CONCLUSIONS A telephone-delivered motivational interviewing-based coaching program for COPD patients is a feasible, well-accepted (by both participants and providers), simple, and novel intervention to improve the well-being of patients with COPD. This pilot study provides insight into a possible alternative to a conventional PR program for patients with limited access to that program.
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Affiliation(s)
- Hamid Rehman
- Pulmonary Medicine, Mayo Clinic Health System, Austin, Minnesota
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Huang B, Willard-Grace R, De Vore D, Wolf J, Chirinos C, Tsao S, Hessler D, Su G, Thom DH. Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial. BMC Pulm Med 2017; 17:90. [PMID: 28599636 PMCID: PMC5466738 DOI: 10.1186/s12890-017-0433-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/31/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) severely hinders quality of life for those affected and is costly to the health care system. Care gaps in areas such as pharmacotherapy, inhaler technique, and knowledge of disease are prevalent, particularly for vulnerable populations served by community clinics. Non-professionally licensed health coaches have been shown to be an effective and cost-efficient solution in bridging care gaps and facilitating self-management for patients with other chronic diseases, but no research to date has explored their efficacy in improving care for people living with COPD. METHOD This is multi-site, single blinded, randomized controlled trial evaluates the efficacy of health coaches to facilitate patient self-management of disease and improve quality of life for patients with moderate to severe COPD. Spirometry, survey, and an exercise capacity test are conducted at baseline and at 9 months. A short survey is administered by phone at 3 and 6 months post-enrollment. The nine month health coaching intervention focuses on enhancing disease understanding and symptom awareness, improving use of inhalers; making personalized plans to increase physical activity, smoking cessation, or otherwise improve disease management; and facilitating care coordination. DISCUSSION The results of this study will provide evidence regarding the efficacy and feasibility of health coaching to improve self-management and quality of life for urban underserved patients with moderate to severe COPD. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02234284 . Registered 12 August 2014.
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Affiliation(s)
- Beatrice Huang
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Denise De Vore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Wolf
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chris Chirinos
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - George Su
- Department of Medicine: Pulmonology, Critical Care, Allergy and Sleep Medicine Program, University of California San Francisco, San Francisco, CA, USA
| | - David H Thom
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
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Sun V, Raz DJ, Ruel N, Chang W, Erhunmwunsee L, Reckamp K, Tiep B, Ferrell B, McCorkle R, Kim JY. A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery. Clin Lung Cancer 2017; 18:e151-e159. [PMID: 28233696 PMCID: PMC5413411 DOI: 10.1016/j.cllc.2017.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility and acceptability of a multimedia self-management (MSM) intervention to prepare patients and family caregivers for lung surgery. PATIENTS AND METHODS This is a quasi-experimental, 2-group, sequential enrollment pilot study of a 4-session multimedia intervention (audio/visual + print) to enhance self-management and quality of life (QOL) for patients and family caregivers. The intervention, Preparing for Lung Surgery, begins before surgery, and continues through hospitalization and discharge, with 2 telephone support sessions after discharge. Outcomes were assessed before surgery (preintervention), at discharge, and 2 to 4 weeks postdischarge (postintervention). Patient outcomes were assessed using the Functional Assessment of Cancer Therapy-General (QOL), MD Anderson Symptom Inventory and Functional Assessment of Cancer Therapy-Pulmonary Symptom Index (symptoms), self-efficacy, surgery-related knowledge, and patient activation. Family caregiver outcomes included City of Hope-QOL-Family (QOL), Caregiver Burden Scale, and knowledge. Paired t tests were used for exploratory evaluations of score changes from pre- to postintervention. RESULTS Sixty participants (38 patients, 22 family caregivers) enrolled in the study (70% accrual). Postintervention scores were significantly improved for patients' emotional QOL (P = .001). Trends for improvements were observed for patient self-efficacy, surgery-related knowledge, and activation. Family caregivers' surgery-related knowledge was significantly improved (P = .02). Overall, participants were highly satisfied with the acceptability/usability of the intervention (3.6-3.7 of 4.0). CONCLUSION A standardized MSM intervention was feasible and acceptable in supporting readiness and preparedness for lung surgery and postoperative recovery. A larger randomized trial is needed to verify the impact of the MSM intervention on patient/family caregiver outcomes and health care resource use.
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Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA.
| | - Dan J Raz
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA
| | - Nora Ruel
- Biostatistics Core, Department of Information Sciences, City of Hope, Duarte, CA
| | - Walter Chang
- Department of Anesthesiology, City of Hope, Duarte, CA
| | | | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Brian Tiep
- Department of Respiratory Diseases and Pulmonary Rehabilitation, City of Hope, Duarte, CA
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | | | - Jae Y Kim
- Division of Thoracic Surgery, Department of Surgery, City of Hope, Duarte, CA
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Abstract
CONTEXT Decreased well-being of healthcare workers expressed as stress and decreased job satisfaction influences patient safety, patient satisfaction, and cost containment. Self-compassion has garnered recent attention due to its positive association with well-being and happiness. Discovering novel pathways to increase the well-being of healthcare workers is essential. OBJECTIVE This study sought to explore the influence of self-compassion on employee happiness in healthcare professionals. DESIGN, SETTING, AND PARTICIPANTS A total of 400 participants (mean age = 45 ± 14, 65% female) healthcare workers at a large teaching hospital were randomly asked to complete questionnaires assessing their levels of happiness and self-compassion, life conditions, and habits. MEASURES Participants completed the Happiness Scale and Self-Compassion Scales, the Five Facet Mindfulness Questionnaire as well as variables associated with well-being: relationship status, the number of hours spent exercising a week, attendance at a wellness facility, and engagement in a regular spiritual practice. RESULTS Self-compassion was significantly and independently associated with perceived happiness explaining 39% of its variance after adjusting for age, marital status, gender, time spent exercising, and attendance to an exercise facility. Two specific subdomains of self-compassion from the instrument used, coping with isolation and mindfulness, accounted for 95% of the self-compassion effect on happiness. CONCLUSION Self-compassion is meaningfully and independently associated with happiness and well-being in healthcare professionals. Our results may have practical implications by providing specific self-compassion components to be targeted in future programs aimed at enhancing well-being in healthcare professionals.
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Sundh J, Janson C, Johansson G, Lindén A, Löfdahl CG, Sandström T, Larsson K. Characterization of secondary care for COPD in Sweden. Eur Clin Respir J 2017; 4:1270079. [PMID: 28326177 PMCID: PMC5328327 DOI: 10.1080/20018525.2016.1270079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 10/31/2022] Open
Abstract
Introduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden. Methods: Information was collected from 29 of 33 existing secondary care units of respiratory medicine in Sweden, using both individual data from 373 consecutively enrolled COPD patients with Global initiative on Obstructive Lung Disease (GOLD) stage III-IV and a structural questionnaire about available resources at the units. Patient data included exacerbations, health status assessed by COPD Assessment Test (CAT), lung function, comorbid conditions, pharmacological treatment and vaccinations. Structural data included available smoking cessation support, multidisciplinary rehabilitation, physical training, patient education and routine follow-up after exacerbations at the respective unit. All patients were reclassified according to the GOLD 2014 group A-D classification. Multiple linear regression investigated associations of available resources with number of exacerbations and CAT score. Results: According to GOLD 2014, 87% of the population were GOLD D and 13% were GOLD C. Triple inhaled therapy were prescribed in 88% of the patients. Over 75% of the units had resources for smoking cessation, multidisciplinary rehabilitation, physical training and patient education. Routine follow-up after exacerbations was available in 35% of the units. Being managed at units with access to structured patient education was associated with statistically significantly fewer exacerbations (adjusted regression coefficient (95% confidence interval) -0.79 (-1.39 to -0.19), p = 0.010). Conclusion: Most stage III-IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Most units have access to smoking cessation, rehabilitation and patient education. Patients managed at units with structured patient education have a lower exacerbation risk.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory; Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Claes-Göran Löfdahl
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Kjell Larsson
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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117
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Thom DH, Wolf J, Gardner H, DeVore D, Lin M, Ma A, Ibarra-Castro A, Saba G. A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes. Ann Fam Med 2016; 14:509-516. [PMID: 28376437 PMCID: PMC5389392 DOI: 10.1370/afm.1988] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/30/2016] [Accepted: 05/24/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Although health coaches are a growing resource for supporting patients in making health decisions, we know very little about the experience of health. We undertook a qualitative study of how health coaches support patients in making decisions and implementing changes to improve their health. METHODS We conducted 6 focus groups (3 in Spanish and 3 in English) with 25 patients and 5 friends or family members, followed by individual interviews with 42 patients, 17 family members, 17 health coaches, and 20 clinicians. Audio recordings were transcribed and analyzed by at least 2 members of the study team in ATLAS.ti using principles of grounded theory to identify themes and the relationship between them. RESULTS We identified 7 major themes that were related to each other in the final conceptual model. Similarities between health coaches and patients and the time health coaches spent with patients helped establish the health coach-patient relationship. The coach-patient relationship allowed for, and was further strengthened by, 4 themes of key coaching activities: education, personal support, practical support, and acting as a bridge between patients and clinicians. CONCLUSIONS We identified a conceptual model that supports the development of a strong relationship, which in turn provides the basis for effective coaching. These results can be used to design health coach training curricula and to support health coaches in practice.
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Affiliation(s)
- David H Thom
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Jessica Wolf
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Heather Gardner
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Denise DeVore
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Michael Lin
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Andy Ma
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Ana Ibarra-Castro
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - George Saba
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Roche N, Bourbeau J. Health Coaching: Another Component of Personalized Medicine for Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2016; 194:647-9. [DOI: 10.1164/rccm.201604-0696ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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