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Choi JY, Ryu EJ. Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process. Int J Chron Obstruct Pulmon Dis 2024; 19:1247-1259. [PMID: 38854589 PMCID: PMC11162182 DOI: 10.2147/copd.s451332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/06/2024] [Indexed: 06/11/2024] Open
Abstract
Background The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve self-management. Purpose This study was a survey to prioritize the relevance of factors associated with non-adherence to COPD self-management using the Delphi technique and analytic hierarchy process (AHP). Patients and Methods A total of 15 expert panels were established to determine the priority of relevant factors in a three-round Delphi survey and an AHP. To develop the preliminary conceptual framework for non-adherence to COPD self-management, findings from a systematic literature review, a qualitative study using in-depth interviews with COPD patients, and the first round of the Delphi survey were integrated. Based on the preliminary framework, the content validity ratio (CVR) was analyzed to examine the consensus among expert panels in the second and third rounds of the Delphi survey, and the relative weight was determined by pairwise comparisons between alternative factors in the AHP. Results In developing the preliminary conceptual framework, 8 factor categories and 53 factors were identified as relevant to non-adherence to COPD self-management. Of the 53 factors, 22 factors with a CVR of 0.49 or higher were identified in the Delphi survey. A total of 14 of the 53 factors were common to both the Delphi survey and AHP with high weights. The most notable factors were prolonged treatment, experience of treatment failure, and unknown effects of medication. Conclusion Through consensus decision-making by experts, 14 factors were identified as relevant factors associated with non-adherence to COPD self-management. A hierarchical and systematic framework incorporating factors associated with non-adherence to COPD self-management was developed in this study. Further research is needed to develop intervention strategies based on factors associated with non-adherence to COPD self-management.
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Affiliation(s)
- Ja Yun Choi
- College of Nursing, Chonnam National University, Chonnam Research Institute of Nursing Science, Gwangju, Republic of Korea
| | - Eui Jeong Ryu
- Department of Nursing, Dongshin University, Naju, Republic of Korea
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Zysman M, Coquelin A, Le Guen N, Solomiac A, Guecamburu M, Erbault M, Blanchard E, Roche N, Morin S. Prevalence and disparities in influenza vaccination among patients with COPD: A French nationwide population study. Respir Med 2024; 226:107606. [PMID: 38522592 DOI: 10.1016/j.rmed.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Despite concordant international recommendations, many surveys found disappointing rates of influenza vaccination in at-risk populations, ranging from 23% in overall COPD population to more than 70% in more severe COPD subjects. Therefore, we assessed the proportion of French COPD patients non-vaccinated for influenza and their clinical and socio-demographic factors. MATERIEL AND METHODS This was a national retrospective study based on the French health insurance database. We identified "diagnosed COPD", defined as subjects hospitalized at least once in 2017 with a principal or associated diagnosis of COPD, and "suspected COPD" as those who were prescribed at least thrice long-acting bronchodilators (LAB), after exclusion of patients with a principal diagnosis or secondary associated diagnosis of asthma or cystic fibrosis, patients deceased before the influenza season and patients hospitalized in long-term or in palliative care unit. Multivariate logistic regression was used to assess the association between patients' characteristics and the lack of influenza vaccination. RESULTS From the national database, 1 474 396 subjects were identified as "suspected COPD" of whom 528 114 were excluded because of previous diagnosis of asthma or cystic fibrosis, and 350 566 as "diagnosed COPD". Among the 1 296 848 patients included, 646 687 patients (53.3%) were vaccinated against influenza. Non-vaccinated subjects were significantly younger (62.1 vs 71.6 years old), more often women (47.9% vs 43.1%) and had fewer comorbidities assessed by Charlson's index (3.0 ± 2.2 vs 4.3 ± 2.1). Lack of vaccination was also associated with a lower LAB usage. Also, non-vaccinated subjects neither had severe exacerbation during the study period. Besides there was a significant heterogeneity in vaccination rate by geographic region, from 47% to 57%. In multivariate analysis, variables independently associated with the lack of influenza vaccination were female gender, younger age, fewer comorbidities and lower socio-economic level. CONCLUSIONS This study using the French exhaustive health insurance database shows that influenza vaccination among COPD patients remains dramatically low and must become a high-priority public-health strategy.
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Affiliation(s)
- Maéva Zysman
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France; Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33604, Pessac, France.
| | - Anaëlle Coquelin
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Nelly Le Guen
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Agnès Solomiac
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Marina Guecamburu
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France
| | - Marie Erbault
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
| | - Elodie Blanchard
- Service des Maladies Respiratoires et des épreuves fonctionnelles respiratoires CHU Bordeaux, 33604, Pessac, France; Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, F-33604, Pessac, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital et Institut Cochin (INSERM UMR 1016), APHP, Université de Paris, Paris, France
| | - Sandrine Morin
- Haute autorité de la santé, 93210, La Plaine Saint-Denis, France
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Delaney S, Cronin P, Huntley-Moore S. Conceptualisations of COPD self-management: A narrative review of the research literature. Chronic Illn 2023; 19:514-528. [PMID: 35876320 DOI: 10.1177/17423953221115441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To examine how self-management is conceptualised in the research literature on chronic obstructive pulmonary disease (COPD). METHODS A narrative review was undertaken to search the research literature on COPD self-management. Ten databases (2000-2021) were searched for published texts. Sixty-two articles met the inclusion criteria. A thematic analysis was conducted of the literature. RESULTS Three conceptualisations of COPD self-management were identified: 1) a dominant medicocentric conceptualisation which represented self-management as medical in focus; 2) a less dominant experiential conceptualisation that viewed it as arising from the experiences of people living with COPD; and 3) a smaller body of literature that attempted to integrate medicocentric and experiential conceptualisations of self-management. DISCUSSION The dominance of the medicocentric conceptualisation of self-management and the polarisation of medicocentric and experiential perspectives were striking. An integrated conceptualisation of self-management has the potential to unite these competing perspectives and promote collaborative relationships between individuals and professionals, so long as the underlying values informing it are made explicit. However, there is a dearth of literature on this approach and it would benefit from more attention. Methods such as Co-production and the Personal Outcomes Approach offer the potential to support an integrated perspective in clinical practice.
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Affiliation(s)
- Sarah Delaney
- Health Research Charities Ireland, Digital Office Centre, 12 Camden Row, Dublin, Ireland
| | - Patricia Cronin
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Sylvia Huntley-Moore
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
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Roque A, Taborda-Barata L, Cruz ÁA, Viegi G, Maricoto T. COPD treatment - a conceptual review based on critical endpoints. Pulmonology 2023; 29:410-420. [PMID: 37030998 DOI: 10.1016/j.pulmoe.2023.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is one of the main causes of death and disability worldwide. Many treatment options are now available, but criteria for choosing inhaled bronchodilators and inhaled corticosteroids have been under discussion. New trials have highlighted the role of patient`s characteristics, such as eosinophil count and exacerbation history, in selecting the most effective personalised treatment option. METHODS In this conceptual review, an in-depth rationale is developed with an integrative approach to COPD treatment, gathering data from the main clinical trials performed so far and that may provide support for actual GOLD 2023 recommendations. RESULTS According to the patient's characteristics and profile, different treatment options, including mono, dual and triple therapies, are presented in a diagram matrix, comparing their efficacy in terms of reduction of exacerbations and mortality risk. DISCUSSION AND CONCLUSION Eosinophil counts and past exacerbation profile may play equally relevant roles to predict the individual risk and the potential response to inhaled corticosteroids. Thus, a comprehensive approach considering these two predictors is needed to aid clinicians decide preventative actions and choice of a first-line or step-up treatment.
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Affiliation(s)
- A Roque
- Santa Joana Family Health Unit, Aveiro Health Centre, Aveiro, Portugal; University of Aveiro, Aveiro, Portugal
| | - L Taborda-Barata
- UBIAir - Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, Covilhã, Portugal; CICS- Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Á A Cruz
- Fundação ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - G Viegi
- Institute of Clinical Physiology (IFC) - National Research Council (CNR), Pisa, Italy
| | - T Maricoto
- UBIAir - Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, Covilhã, Portugal; CICS- Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Beira Ria Health Center, Aveiro Health Centre, Ílhavo, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
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Effing TW. Developments in respiratory self-management interventions over the last two decades. Chron Respir Dis 2023; 20:14799731231221819. [PMID: 38129363 DOI: 10.1177/14799731231221819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This paper describes developments in the fields of asthma and COPD self-management interventions (SMIs) over the last two decades and discusses future directions. Evidence around SMIs has exponentially grown. Efficacy on group level is convincing and both asthma and COPD SMIs are currently recommended by respiratory guidelines. Core components of asthma SMIs are defined as education, action plans, and regular review, with some discussion about self-monitoring. Exacerbation action plans are defined as an integral part of COPD management. Patient's adherence to SMI's is however inadequate and significantly reducing the intervention's impact. Adherence could be improved by tailoring of SMIs to patients' needs, health beliefs, and capabilities; the use of shared decision making; and optimising the communication between patients and health care providers. Due to the COVID-19 pandemic, digital health innovations have rapidly been introduced and expanded. Digital technology use may increase efficiency, flexibility, and efficacy of SMIs. Furthermore, artificial intelligence can be used to e.g., predict exacerbations in action plans. Research around digital health innovations to ensure evidence-based practice is of utmost importance. Current implementation of respiratory SMIs is not satisfactory. Implementation research should be used to generate further insights, with cost-effectiveness, policy (makers), and funding being significant determinants.
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Affiliation(s)
- Tanja W Effing
- College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Feng L, Lv X, Wang Y, Chu S, Dai Z, Jing H, Tong Z, Liao X, Liang L. Developments in smoking cessation interventions for patients with chronic obstructive pulmonary disease in the past 5 years: a scoping review. Expert Rev Respir Med 2022; 16:749-764. [PMID: 35916493 DOI: 10.1080/17476348.2022.2108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Smoking cessation is the most effective strategy for slowing the progression of chronic obstructive pulmonary disease (COPD). However, COPD patients find it difficult to quit smoking with standard cessation interventions. AREAS COVERED A scoping review of smoking cessation for COPD patients was conducted by searching the MEDLINE, Embase, and Cochrane Library databases for all studies published between 1 January 2016 and 22 September 2021. Four themes were set up and 47 studies were included eventually. The majority of the included studies (61.7%, 29/47) investigated efficacy and effectiveness, including new strategies for extended treatment and mobile health (mHealth) delivery approach. Studies examining accessibility and utilization (31.9%, 15/47), safety (10.6%, 5/47), and health economics (6.4%, 3/47) were also reviewed. The quality of the included randomized controlled trials was also evaluated. EXPERT OPINION Pharmacotherapy combined with behavioral interventions delivered via mHealth may be a promising strategy to help COPD smokers quit. However, the overall quality of the current studies is poor, making it challenging for clinicians to make informed decisions. Future high-quality studies are needed to provide conclusive evidence on the optimal pharmacotherapies and the most cost-effective comprehensive smoking cessation interventions, particularly those integrated into disease management for smokers with COPD.
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Affiliation(s)
- Lin Feng
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoshuang Lv
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingquan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuilian Chu
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zeqi Dai
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Hang Jing
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing Liao
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Lirong Liang
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Zareban I, Araban M, Rohani MR, Karimy M, Zamani-Alavijeh F, Babanejad M, Stein LAR. High blood pressure self-care among hypertensive patients in Iran: a theory-driven study. J Hum Hypertens 2022; 36:445-452. [PMID: 33077805 DOI: 10.1038/s41371-020-00429-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.
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Affiliation(s)
- Iraj Zareban
- Health Promotion Research Center, Zahedan of University Medical Sciences, Zahedan, Iran
| | - Marzieh Araban
- Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Rohani
- Internal Medicine Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mahmood Karimy
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Fereshteh Zamani-Alavijeh
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Babanejad
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - L A R Stein
- Department of Social & Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral Health, Developmental Disabilities & Hospitals, Cranston, RI, USA.,Rhode Island Training School, Department of Children, Youth & Families, Cranston, RI, USA.,Department of Psychology, University of Rhode Island, South Kingstown, RI, USA
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Gillespie D, Francis N, Ahmed H, Hood K, Llor C, White P, Thomas-Jones E, Stanton H, Sewell B, Phillips R, Naik G, Melbye H, Lowe R, Kirby N, Cochrane A, Bates J, Alam MF, Butler C. Associations with Post-Consultation Health-Status in Primary Care Managed Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:383-394. [PMID: 35210767 PMCID: PMC8859472 DOI: 10.2147/copd.s340710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background It has been demonstrated that antibiotic prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) can be safely reduced in primary care when general practitioners have access to C-reactive protein (CRP) rapid testing. Aim To investigate the factors associated with post-consultation COPD health status in patients presenting with AECOPD in this setting. Design and Setting A cohort study of patients enrolled in a randomised controlled trial. Patients aged 40+ years with a clinical diagnosis of COPD who presented in primary care across England and Wales with an AECOPD were included. Methods Participants were contacted for follow-up at one- and two-weeks by phone and attended the practice four weeks after the index consultation. The outcome of interest was the Clinical COPD Questionnaire (CCQ) score. Multivariable multilevel linear regression models fitted to examine the factors associated with COPD health status in the four-weeks following consultation for an AECOPD. Results A total of 649 patients were included, with 1947 CCQ total scores analysed. Post-consultation CCQ total scores were significantly higher (worse) in participants with diabetes (adjusted mean difference [AMD]=0.26; 95% confidence interval (CI) 0.08–0.45), obese patients compared to those with normal body mass index (AMD = 0.25, 95% CI 0.07–0.43), and those who were prescribed oral antibiotics in the prior 12 months (AMD = 0.26; 95% CI 0.11–0.41), but only the two latter associations remained after adjusting for other sociodemographic variables. Conclusion COPD health status was worse in the four weeks following primary care consultation for AECOPD in patients with obesity and those prescribed oral antibiotics in the preceding year.
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Affiliation(s)
- David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
- Correspondence: David Gillespie, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, England, OX2 6GG, UK, Email
| | - Nick Francis
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, UK
| | - Haroon Ahmed
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Carl Llor
- University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Patrick White
- School of Population Health and Environmental Sciences, Kings College London, London, England, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Helen Stanton
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, UK
| | - Rhiannon Phillips
- Cardiff School of Sport & Health Science, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Gurudutt Naik
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Rachel Lowe
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Nigel Kirby
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, England, UK
| | - Janine Bates
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
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Cravo A, Attar D, Freeman D, Holmes S, Ip L, Singh SJ. The Importance of Self-Management in the Context of Personalized Care in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:231-243. [PMID: 35095272 PMCID: PMC8791295 DOI: 10.2147/copd.s343108] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/13/2023] Open
Abstract
Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.
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Affiliation(s)
- Ana Cravo
- Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Darush Attar
- North Central London Clinical Commissioning Group (CCG), London, UK
| | | | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Correspondence: Steve Holmes The Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel +44 1749 334383 Email
| | - Lindsay Ip
- King’s Health Partners and Ealing Community Partners, London, UK
| | - Sally J Singh
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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Singh D, Holmes S, Adams C, Bafadhel M, Hurst JR. Overcoming Therapeutic Inertia to Reduce the Risk of COPD Exacerbations: Four Action Points for Healthcare Professionals. Int J Chron Obstruct Pulmon Dis 2021; 16:3009-3016. [PMID: 34754186 PMCID: PMC8570921 DOI: 10.2147/copd.s329316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/18/2021] [Indexed: 12/26/2022] Open
Abstract
Background Therapeutic inertia, defined as failure to escalate or initiate adequate therapy when treatment goals are not met, contributes to poor management of COPD exacerbations. Methods A multidisciplinary panel of five expert clinicians actively managing COPD and representative of UK practice developed action points to reduce exacerbation risk, based on evidence, clinical expertise, and experience. The action points are applicable despite changing circumstances (eg, virtual clinics). The panel agreed areas where further evidence is needed. Results The four action points were (1) an experienced HCP, such as a GP or member of the multi-professional COPD team should review patients within one month of every exacerbation that requires oral steroids, antibiotics, or hospitalization to address modifiable risk factors, optimize non-pharmacological measures, and evaluate pharmacological therapy. (2) Presenting to hospital with an exacerbation defines an important window of opportunity to reduce the risk of further exacerbations. Follow-up by a GP, or member of the multi-professional specialist COPD team within one month of discharge with a full management review and appropriate escalation of pharmacological treatment is essential. (3) Healthcare professionals (HCPs) in all healthcare settings should be able to recognize COPD exacerbations, refer as appropriate and document the episode accurately in medical records across service boundaries. HCPs should support patients to recognize and report exacerbations. (4) HCPs should intervene proactively based on risk assessments, disease activity and any treatable traits at or as soon as possible after diagnosis and annually thereafter. Delivering these action points needs coordinated action with policymakers, funders, and service providers. Conclusion These action points should be a fundamental part of clinical practice to determine if a change in management is necessary to reduce the risk of exacerbations. Policymakers should use these action points to develop systems and initiatives that reduce the risk of further exacerbations.
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Hospitals Trust, Manchester, UK
| | | | - Claire Adams
- Tees Valley Clinical Commissioning Group, Middlesbrough, UK
| | - Mona Bafadhel
- Nuffield Department Clinical Medicine, University of Oxford, Oxford, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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11
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Adab P, Jordan RE, Fitzmaurice D, Ayres JG, Cheng KK, Cooper BG, Daley A, Dickens A, Enocson A, Greenfield S, Haroon S, Jolly K, Jowett S, Lambe T, Martin J, Miller MR, Rai K, Riley RD, Sadhra S, Sitch A, Siebert S, Stockley RA, Turner A. Case-finding and improving patient outcomes for chronic obstructive pulmonary disease in primary care: the BLISS research programme including cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Chronic obstructive pulmonary disease is a major contributor to morbidity, mortality and health service costs but is vastly underdiagnosed. Evidence on screening and how best to approach this is not clear. There are also uncertainties around the natural history (prognosis) of chronic obstructive pulmonary disease and how it impacts on work performance.
Objectives
Work package 1: to evaluate alternative methods of screening for undiagnosed chronic obstructive pulmonary disease in primary care, with clinical effectiveness and cost-effectiveness analyses and an economic model of a routine screening programme. Work package 2: to recruit a primary care chronic obstructive pulmonary disease cohort, develop a prognostic model [Birmingham Lung Improvement StudieS (BLISS)] to predict risk of respiratory hospital admissions, validate an existing model to predict mortality risk, address some uncertainties about natural history and explore the potential for a home exercise intervention. Work package 3: to identify which factors are associated with employment, absenteeism, presenteeism (working while unwell) and evaluate the feasibility of offering formal occupational health assessment to improve work performance.
Design
Work package 1: a cluster randomised controlled trial with household-level randomised comparison of two alternative case-finding approaches in the intervention arm. Work package 2: cohort study – focus groups. Work package 3: subcohort – feasibility study.
Setting
Primary care settings in West Midlands, UK.
Participants
Work package 1: 74,818 people who have smoked aged 40–79 years without a previous chronic obstructive pulmonary disease diagnosis from 54 general practices. Work package 2: 741 patients with previously diagnosed chronic obstructive pulmonary disease from 71 practices and participants from the work package 1 randomised controlled trial. Twenty-six patients took part in focus groups. Work package 3: occupational subcohort with 248 patients in paid employment at baseline. Thirty-five patients took part in an occupational health intervention feasibility study.
Interventions
Work package 1: targeted case-finding – symptom screening questionnaire, administered opportunistically or additionally by post, followed by diagnostic post-bronchodilator spirometry. The comparator was routine care. Work package 2: twenty-three candidate variables selected from literature and expert reviews. Work package 3: sociodemographic, clinical and occupational characteristics; occupational health assessment and recommendations.
Main outcome measures
Work package 1: yield (screen-detected chronic obstructive pulmonary disease) and cost-effectiveness of case-finding; effectiveness of screening on respiratory hospitalisation and mortality after approximately 4 years. Work package 2: respiratory hospitalisation within 2 years, and barriers to and facilitators of physical activity. Work package 3: work performance – feasibility and acceptability of the occupational health intervention and study processes.
Results
Work package 1: targeted case-finding resulted in greater yield of previously undiagnosed chronic obstructive pulmonary disease than routine care at 1 year [n = 1278 (4%) vs. n = 337 (1%), respectively; adjusted odds ratio 7.45, 95% confidence interval 4.80 to 11.55], and a model-based estimate of a regular screening programme suggested an incremental cost-effectiveness ratio of £16,596 per additional quality-adjusted life-year gained. However, long-term follow-up of the trial showed that at ≈4 years there was no clear evidence that case-finding, compared with routine practice, was effective in reducing respiratory admissions (adjusted hazard ratio 1.04, 95% confidence interval 0.73 to1.47) or mortality (hazard ratio 1.15, 95% confidence interval 0.82 to 1.61). Work package 2: 2305 patients, comprising 1564 with previously diagnosed chronic obstructive pulmonary disease and 741 work package 1 participants (330 with and 411 without obstruction), were recruited. The BLISS prognostic model among cohort participants with confirmed airflow obstruction (n = 1894) included 6 of 23 candidate variables (i.e. age, Chronic Obstructive Pulmonary Disease Assessment Test score, 12-month respiratory admissions, body mass index, diabetes and forced expiratory volume in 1 second percentage predicted). After internal validation and adjustment (uniform shrinkage factor 0.87, 95% confidence interval 0.72 to 1.02), the model discriminated well in predicting 2-year respiratory hospital admissions (c-statistic 0.75, 95% confidence interval 0.72 to 0.79). In focus groups, physical activity engagement was related to self-efficacy and symptom severity. Work package 3: in the occupational subcohort, increasing dyspnoea and exposure to inhaled irritants were associated with lower work productivity at baseline. Longitudinally, increasing exacerbations and worsening symptoms, but not a decline in airflow obstruction, were associated with absenteeism and presenteeism. The acceptability of the occupational health intervention was low, leading to low uptake and low implementation of recommendations and making a full trial unfeasible.
Limitations
Work package 1: even with the most intensive approach, only 38% of patients responded to the case-finding invitation. Management of case-found patients with chronic obstructive pulmonary disease in primary care was generally poor, limiting interpretation of the long-term effectiveness of case-finding on clinical outcomes. Work package 2: the components of the BLISS model may not always be routinely available and calculation of the score requires a computerised system. Work package 3: relatively few cohort participants were in paid employment at baseline, limiting the interpretation of predictors of lower work productivity.
Conclusions
This programme has addressed some of the major uncertainties around screening for undiagnosed chronic obstructive pulmonary disease and has resulted in the development of a novel, accurate model for predicting respiratory hospitalisation in people with chronic obstructive pulmonary disease and the inception of a primary care chronic obstructive pulmonary disease cohort for longer-term follow-up. We have also identified factors that may affect work productivity in people with chronic obstructive pulmonary disease as potential targets for future intervention.
Future work
We plan to obtain data for longer-term follow-up of trial participants at 10 years. The BLISS model needs to be externally validated. Our primary care chronic obstructive pulmonary disease cohort is a unique resource for addressing further questions to better understand the prognosis of chronic obstructive pulmonary disease.
Trial registration
Current Controlled Trials ISRCTN14930255.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peymané Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon G Ayres
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - KK Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tosin Lambe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Martin R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Steve Sadhra
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Robert A Stockley
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Savran O, Godtfredsen N, Sørensen T, Jensen C, Ulrik CS. Characteristics of COPD Patients Prescribed ICS Managed in General Practice vs. Secondary Care. COPD 2021; 18:493-500. [PMID: 34470537 DOI: 10.1080/15412555.2021.1970737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Inhaled corticosteroids (ICS) for COPD have been much debated. Our aim was to investigate characteristics of ICS prescribed COPD patients managed only in general practice compared to those also managed in secondary care. Participating general practitioners recruited patients with COPD (ICPC 2nd ed. code R95) currently prescribed ICS (ACT code R03AK and R03BA). Data on demographics, comorbidities, smoking habits, spirometry, dyspnea score and exacerbation history were retrieved from medical records. Logistic regression analysis was applied to detect predictors associated with management in secondary care. 2,279 COPD patients (45% males and mean age 71 years) were recruited in primary care. Compared to patients managed in primary care only (n = 1,179), patients also managed in secondary care (n = 560) were younger (p = 0.013), had lower BMI, more life-time tobacco exposure (p = 0.03), more exacerbations (p < 0.001) and hospitalizations (p < 0.001) and lower FEV1/FVC-ratio (0.59 versus 0.52, respectively). Compared to patients managed in only primary care, logistic regression analysis revealed that management also in secondary care was associated to MRC-score ≥3 (OR 2.70; 95% CI 1.50-4.86; p = 0.001), FEV1%pred (OR 0.98; 95% CI 0.95 to 0.99; p = 0.036), and systemic corticosteroids for COPD exacerbation (OR 1.44; 95% CI 1.10-1.89; p = 0.008). In COPD patients prescribed ICS recruited in primary care, patients also managed in secondary care had more respiratory symptoms, lower lung function and exacerbations treated with systemic corticosteroids indicating that the most severe COPD patients, in general, are referred for specialist care.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Hvidovre, Denmark
| | | | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Hvidovre, Denmark
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Paciocco S, Kothari A, Licskai CJ, Ferrone M, Sibbald SL. Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study. BMC Health Serv Res 2021; 21:717. [PMID: 34289847 PMCID: PMC8293496 DOI: 10.1186/s12913-021-06636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used. METHODS A qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site. RESULTS Eleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead. CONCLUSIONS This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.
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Affiliation(s)
- Stefan Paciocco
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Anita Kothari
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Christopher J Licskai
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Shannon L Sibbald
- School of Health Studies, Faculty of Health Sciences, Department of Family Medicine, Schulich School of Medicine and Dentistry, The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Gillespie D, Butler CC, Bates J, Hood K, Melbye H, Phillips R, Stanton H, Alam MF, Cals JW, Cochrane A, Kirby N, Llor C, Lowe R, Naik G, Riga E, Sewell B, Thomas-Jones E, White P, Francis NA. Associations with antibiotic prescribing for acute exacerbation of COPD in primary care: secondary analysis of a randomised controlled trial. Br J Gen Pract 2021; 71:e266-e272. [PMID: 33657007 PMCID: PMC8007268 DOI: 10.3399/bjgp.2020.0823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/23/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND C-reactive protein (CRP) point-of-care testing can reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care, without compromising patient care. Further safe reductions may be possible. AIM To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in primary care. DESIGN AND SETTING Secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care (the PACE trial). METHOD Clinicians collected participants' demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made after participants were randomised to receive a point-of-care CRP measurement or usual care. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing, and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20 mg/l, or CRP ≥20 mg/l). RESULTS A total of 649 participants from 86 general practices across England and Wales were included. Odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio [AOR] = 5.22, 95% confidence interval [CI] = 3.24 to 8.41), wheeze (AOR = 1.64, 95% CI = 1.07 to 2.52), diminished vesicular breathing (AOR = 2.95, 95% CI = 1.70 to 5.10), or clinician-reported evidence of consolidation (AOR = 34.40, 95% CI = 2.84 to 417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per additional year increase = 0.98, 95% CI = 0.95 to 1.00), as was the presence of heart failure (AOR = 0.32, 95% CI = 0.12 to 0.85). CONCLUSION Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. Diagnostic and prognostic value of these features may help identify further safe reductions.
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Affiliation(s)
- David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Janine Bates
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Rhiannon Phillips
- Cardiff School of Sport and Health Science, Cardiff Metropolitan University, Cardiff, UK
| | - Helen Stanton
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Jochen Wl Cals
- Department of Family Medicine, School for Public Health and Primary Care, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Nigel Kirby
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Carl Llor
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Rachel Lowe
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Gurudutt Naik
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Evgenia Riga
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Patrick White
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nick A Francis
- Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
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Sajith M, Bargaje MD, Gharat S, Mathew J, Varghese A. Assessment of the effectiveness of a pharmacist approach for improving disease-specific knowledge and treatment in patients with chronic obstructive pulmonary disease. Eur J Hosp Pharm 2020; 28:e97-e101. [PMID: 33051196 DOI: 10.1136/ejhpharm-2020-002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Adequate knowledge is essential for the appropriate management of chronic conditions such as chronic obstructive pulmonary disease (COPD). However, some patients may not be able either to comprehend or obtain adequate information. This study aims to assess the effectiveness of the clinical pharmacist approach to refining disease-specific knowledge in patients with COPD treated in a tertiary care hospital. METHODS A prospective observational longitudinal study was carried out in adult COPD patients for 9 months in the tertiary care hospital of Pune. At the time of enrolment, disease-specific knowledge of patients with COPD was assessed using the Bristol COPD Knowledge Questionnaire (BCKQ). After the assessment, patients were educated, counselled verbally and provided with a validated COPD information leaflet. The patients' knowledge was reassessed 1 month and 3 months after enrolment. Pre and post scores of BCKQ were compared by ANOVA followed by Tukey's post hoc test. The difference in the proportions was calculated using the χ2 test. RESULTS Of 75 patients, the majority were men (53.33%), aged >60 years (72%), employed (62.67%) and had obtained secondary education (37.33%). The mean baseline BCKQ overall score of the patients was 25.87, which increased after education to 42.43 on the first visit (1 month) and to 45.62 on the second visit (3 months) (p<0.0001). At baseline, the topics 'vaccination', 'inhaled steroids' and 'antibiotics' returned the lowest mean scores of 0.37, 0.38 and 0.60, which were increased to 2.30, 2.70 and 2.72, respectively, after follow-up. CONCLUSION The knowledge of patients with COPD about the disease and its treatment was poor at the time of enrolment. Proper counselling and education provided by the clinical pharmacist helped to improve the patients' knowledge about COPD and its treatment.
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Affiliation(s)
- Manjusha Sajith
- Clinical Pharmacy, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | | | - Smruti Gharat
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Joelin Mathew
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Amruta Varghese
- Clinical Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
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Lundell S, Wadell K, Wiklund M, Tistad M. Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD. COPD 2020; 17:533-542. [DOI: 10.1080/15412555.2020.1824217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sara Lundell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Napolitano F, Della Polla G, Capano MS, Augimeri M, Angelillo IF. Vaccinations and Chronic Diseases: Knowledge, Attitudes, and Self-Reported Adherence among Patients in Italy. Vaccines (Basel) 2020; 8:vaccines8040560. [PMID: 32992864 PMCID: PMC7711873 DOI: 10.3390/vaccines8040560] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
The aims of this cross-sectional survey were to evaluate the knowledge, attitudes, and self-reported adherence to recommended vaccinations among a random sample of patients with chronic conditions presenting for a medical visit in out-patient clinics in Italy. Patients who were healthcare workers (HCWs), those with diabetes, those who had received information by Internet, physicians, and friends/relatives, and those who needed more information were more likely to know that the influenza vaccine is recommended for patients with chronic diseases. More than half (58.2%) and 8.9% self-reported to have received at least one recommended vaccination and more than one, respectively. Patients who believed that vaccine-preventable diseases (VPDs) were dangerous for them, those who had received information by physicians, and those who needed information were more likely to have received at least one recommended vaccination. This behavior was less likely in married patients, those who were worried about the side effects of the vaccines, and those who suffered from renal failure. The results highlight the need to implement effective vaccination programs in order to decrease the complication of VPDs in at-risk population.
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Francis NA, Gillespie D, White P, Bates J, Lowe R, Sewell B, Phillips R, Stanton H, Kirby N, Wootton M, Thomas-Jones E, Hood K, Llor C, Cals J, Melbye H, Naik G, Gal M, Fitzsimmons D, Alam MF, Riga E, Cochrane A, Butler CC. C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT. Health Technol Assess 2020; 24:1-108. [PMID: 32202490 PMCID: PMC7132534 DOI: 10.3310/hta24150] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care are prescribed antibiotics, but these may not be beneficial, and they can cause side effects and increase the risk of subsequent resistant infections. Point-of-care tests (POCTs) could safely reduce inappropriate antibiotic prescribing and antimicrobial resistance. OBJECTIVE To determine whether or not the use of a C-reactive protein (CRP) POCT to guide prescribing decisions for AECOPD reduces antibiotic consumption without having a negative impact on chronic obstructive pulmonary disease (COPD) health status and is cost-effective. DESIGN A multicentre, parallel-arm, randomised controlled open trial with an embedded process, and a health economic evaluation. SETTING General practices in Wales and England. A UK NHS perspective was used for the economic analysis. PARTICIPANTS Adults (aged ≥ 40 years) with a primary care diagnosis of COPD, presenting with an AECOPD (with at least one of increased dyspnoea, increased sputum volume and increased sputum purulence) of between 24 hours' and 21 days' duration. INTERVENTION CRP POCTs to guide antibiotic prescribing decisions for AECOPD, compared with usual care (no CRP POCT), using remote online randomisation. MAIN OUTCOME MEASURES Patient-reported antibiotic consumption for AECOPD within 4 weeks post randomisation and COPD health status as measured with the Clinical COPD Questionnaire (CCQ) at 2 weeks. For the economic evaluation, patient-reported resource use and the EuroQol-5 Dimensions were included. RESULTS In total, 653 participants were randomised from 86 general practices. Three withdrew consent and one was randomised in error, leaving 324 participants in the usual-care arm and 325 participants in the CRP POCT arm. Antibiotics were consumed for AECOPD by 212 out of 274 participants (77.4%) and 150 out of 263 participants (57.0%) in the usual-care and CRP POCT arm, respectively [adjusted odds ratio 0.31, 95% confidence interval (CI) 0.20 to 0.47]. The CCQ analysis comprised 282 and 281 participants in the usual-care and CRP POCT arms, respectively, and the adjusted mean CCQ score difference at 2 weeks was 0.19 points (two-sided 90% CI -0.33 to -0.05 points). The upper limit of the CI did not contain the prespecified non-inferiority margin of 0.3. The total cost from a NHS perspective at 4 weeks was £17.59 per patient higher in the CRP POCT arm (95% CI -£34.80 to £69.98; p = 0.408). The mean incremental cost-effectiveness ratios were £222 per 1% reduction in antibiotic consumption compared with usual care at 4 weeks and £15,251 per quality-adjusted life-year gained at 6 months with no significant changes in sensitivity analyses. Patients and clinicians were generally supportive of including CRP POCT in the assessment of AECOPD. CONCLUSIONS A CRP POCT diagnostic strategy achieved meaningful reductions in patient-reported antibiotic consumption without impairing COPD health status or increasing costs. There were no associated harms and both patients and clinicians valued the diagnostic strategy. FUTURE WORK Implementation studies that also build on our qualitative findings could help determine the effect of this intervention over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN24346473. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - David Gillespie
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Patrick White
- Department of Primary Care & Public Health Sciences, King's College London, London, UK
| | - Janine Bates
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Rachel Lowe
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rhiannon Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Stanton
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Nigel Kirby
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, University Hospital of Wales, Cardiff, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Carl Llor
- University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
| | - Jochen Cals
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Gurudutt Naik
- Department of Wound Healing, University Hospital Wales, Cardiff, UK
| | - Micaela Gal
- Wales Primary and Emergency Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Mohammed Fasihul Alam
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Evgenia Riga
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ann Cochrane
- Department of Primary Care & Public Health Sciences, King's College London, London, UK
| | - Christopher C Butler
- Primary Care and Vaccines Collaborative Clinical Trials Unit, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Alves KCG, Guimarães RA, de Souza MR, de Morais Neto OL. Evaluation of the primary care for chronic diseases in the high coverage context of the Family Health Strategy. BMC Health Serv Res 2019; 19:913. [PMID: 31783845 PMCID: PMC6884915 DOI: 10.1186/s12913-019-4737-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This cross-sectional study evaluated the adequacy of the Family Health Strategy for the primary care model for chronic noncommunicable diseases and the changes that occurred between the two cycles of external evaluations of the National Program for Improving Access and Quality of Primary Care, which took place in 2012 and 2014, in the higher coverage context of the Family Health Strategy of Brazil, in the state of Tocantins, Brazil. METHODS The data source contained information on the infrastructure of the 233 Primary Health Units and on the work process of 266 health teams. The Principal Component Analysis for Categorical Data technique and the McNemar chi-squared statistical test for comparing paired samples were used, and a significance level of 5% with a 95% Confidence Interval was used. RESULTS The analysis identified a low proportion of dispensing of medications for the treatment of chronic disease in both cycles. There was a significant increase in seasonal influenza vaccination, in the number of sterilization, procedure, dressings and inhalation rooms. There was a small but significant reduction in the materials for cervical cancer screening, although they are available in almost 90.0% of the PHUs. More than 70.0% of the health teams carried out additional health education activities, encouraged physical activity, registered schoolchildren with health needs for monitoring, evaluated user satisfaction and user referral. CONCLUSIONS The findings of this study highlighted the improvement of the structure of the Primary Health Units, but identified a low provision of medicines to treat chronic diseases. The health promotion was performed as the main work process tool of family health teams, but it was little focused on intersectoral actions and on actions with the population in the area or on the empowerment of users through self-management support for chronic diseases. Furthermore, it is critical that the Family Health Strategy in Tocantins be organized and focused on the care of chronic diseases to improve and adapt itself to a primary chronic care model.
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Affiliation(s)
- Kelly Cristina Gomes Alves
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil. .,Department of Medicine, Federal University of Tocantins, Palmas, Brazil.
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Marta Rovery de Souza
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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20
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Revue générale sur l’adhésion aux traitements inhalés de la BPCO. Rev Mal Respir 2019; 36:801-849. [DOI: 10.1016/j.rmr.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
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21
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Incorporating Household Spillovers in Cost Utility Analysis: A Case Study Using Behavior Change in COPD. Int J Technol Assess Health Care 2019; 35:212-220. [PMID: 31064563 DOI: 10.1017/s026646231900028x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is important to capture all health effects of interventions in cost-utility analyses conducted under a societal or healthcare perspective. However, this is rarely done. Household spillovers (health effects on patients' other household members) may be particularly likely in the context of technologies and interventions to change behaviors that are interdependent in the household. Our objective was to prospectively collect outcome data from household members and illustrate how these can be included in a cost-utility analysis of a behavior change intervention in chronic obstructive pulmonary disease (COPD). METHODS Data were collected from patients' household members (n = 153) alongside a randomized controlled trial of a COPD self-management intervention. The impact of the intervention on household members' EQ-5D-5L scores (primary outcome), was evaluated. Analyses were then carried out to estimate household members' quality-adjusted life-years (QALYs) and assess the impact of including these QALYs on cost-effectiveness. RESULTS The intervention had a negligible spillover on household members' EQ-5D-5L scores (-0.007; p = .75). There were also no statistically significant spillovers at the 5 percent level in household member secondary outcomes. In the base-case model, the inclusion of household member QALYs in the incremental cost-effectiveness ratio (ICER) denominator marginally increased the ICER from GBP 10,271 (EUR 13,146) to GBP 10,991 (EUR 14,068) per QALY gained. CONCLUSIONS This study demonstrates it is feasible to prospectively collect and include household members' outcome data in cost utility analysis, although the study highlighted several methodological issues. In this case, the intervention did not impact significantly on household members' health or health behaviors, but inclusion of household spillovers may make a difference in other contexts.
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22
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Ferrone M, Masciantonio MG, Malus N, Stitt L, O'Callahan T, Roberts Z, Johnson L, Samson J, Durocher L, Ferrari M, Reilly M, Griffiths K, Licskai CJ. The impact of integrated disease management in high-risk COPD patients in primary care. NPJ Prim Care Respir Med 2019; 29:8. [PMID: 30923313 PMCID: PMC6438975 DOI: 10.1038/s41533-019-0119-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/26/2019] [Indexed: 12/23/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a reduced quality of life (QoL) and exacerbations that drive health service utilization (HSU). A majority of patients with COPD are managed in primary care. Our objective was to evaluate an integrated disease management, self-management, and structured follow-up intervention (IDM) for high-risk patients with COPD in primary care. This was a one-year multi-center randomized controlled trial. High-risk, exacerbation-prone COPD patients were randomized to IDM provided by a certified respiratory educator and physician, or usual physician care. IDM received case management, self-management education, and skills training. The primary outcome, COPD-related QoL, was measured using the COPD Assessment Test (CAT). Of 180 patients randomized from 8 sites, 81.1% completed the study. Patients were 53.6% women, mean age 68.2 years, post-bronchodilator FEV1 52.8% predicted, and 77.4% were Global Initiative for Obstructive Lung Disease Stage D. QoL-CAT scores improved in IDM patients, 22.6 to 14.8, and worsened in usual care, 19.3 to 22.0, adjusted difference 9.3 (p < 0.001). Secondary outcomes including the Clinical COPD Questionnaire, Bristol Knowledge Questionnaire, and FEV1 demonstrated differential improvements in favor of IDM of 1.29 (p < 0.001), 29.6% (p < 0.001), and 100 mL, respectively (p = 0.016). Compared to usual care, significantly fewer IDM patients had a severe exacerbation, -48.9% (p < 0.001), required an urgent primary care visit for COPD, -30.2% (p < 0.001), or had an emergency department visit, -23.6% (p = 0.001). We conclude that IDM self-management and structured follow-up substantially improved QoL, knowledge, FEV1, reduced severe exacerbations, and HSU, in a high-risk primary care COPD population. Clinicaltrials.gov NCT02343055.
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Affiliation(s)
- Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Marcello G Masciantonio
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Natalie Malus
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Western University, London Health Sciences Centre, London, ON, Canada
| | - Larry Stitt
- Lawson Health Research Institute, London, ON, Canada
| | | | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Laura Johnson
- Chatham Kent Family Health Team, Chatham, ON, Canada
| | - Jim Samson
- Leamington Family Health Team, Leamington, ON, Canada
| | - Lisa Durocher
- Leamington Family Health Team, Leamington, ON, Canada
| | | | | | | | - Christopher J Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- Western University, London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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23
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Jolly K, Sidhu MS, Bates E, Majothi S, Sitch A, Bayliss S, Kim HJS, Jordan RE. Systematic review of the effectiveness of community-based self-management interventions among primary care COPD patients. NPJ Prim Care Respir Med 2018; 28:44. [PMID: 30470741 PMCID: PMC6251904 DOI: 10.1038/s41533-018-0111-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/23/2018] [Indexed: 11/08/2022] Open
Abstract
COPD self-management reduces hospital admissions and improves health-related quality of life (HRQoL). However, whilst most patients are managed in primary care, the majority of self-management trials have recruited participants with more severe disease from secondary care. We report the findings of a systematic review of the effectiveness of community-based self-management interventions in primary care patients with COPD. We systematically searched eleven electronic databases and identified 12 eligible randomised controlled trials with seven included in meta-analyses for HRQoL, anxiety and depression. We report no difference in HRQoL at final follow-up (St George's Respiratory Questionnaire total score -0.29; 95%CI -2.09, 1.51; I2 0%), nor any difference in anxiety or depression. In conclusion, supported self-management interventions delivered in the community to patients from primary care do not appear to be effective. Further research is recommended to identify effective self-management interventions suitable for primary care populations, particularly those with milder disease.
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Affiliation(s)
- K Jolly
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - M S Sidhu
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - E Bates
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Majothi
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - A Sitch
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Bayliss
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H J Samuel Kim
- St John's College, University of Oxford, Oxford, OX1 3JP, UK
| | - R E Jordan
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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24
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Tistad M, Lundell S, Wiklund M, Nyberg A, Holmner Å, Wadell K. Usefulness and Relevance of an eHealth Tool in Supporting the Self-Management of Chronic Obstructive Pulmonary Disease: Explorative Qualitative Study of a Cocreative Process. JMIR Hum Factors 2018; 5:e10801. [PMID: 30368440 PMCID: PMC6229513 DOI: 10.2196/10801] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives. OBJECTIVE The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers. METHODS Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis. RESULTS The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge. CONCLUSIONS The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.
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Affiliation(s)
- Malin Tistad
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Sara Lundell
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - André Nyberg
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Åsa Holmner
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Karin Wadell
- Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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25
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Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, Balcells E, Benet M, Borrell E, Celorrio N, Delgado A, Jané C, Marin A, Martín-Cantera C, Monteagudo M, Montellà N, Muñoz L, Ortega P, Rodríguez DA, Rodríguez-Roisin R, Simonet P, Torán-Monserrat P, Torrent-Pallicer J, Vall-Casas P, Vilaró J, Garcia-Aymerich J. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial. Eur Respir J 2018; 52:13993003.00063-2018. [PMID: 30166322 PMCID: PMC6203405 DOI: 10.1183/13993003.00063-2018] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023]
Abstract
There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease (COPD). We assessed 12-month efficacy and effectiveness of the Urban Training intervention on physical activity in COPD patients. This randomised controlled trial (NCT01897298) allocated 407 COPD patients from primary and hospital settings 1:1 to usual care (n=205) or Urban Training (n=202). Urban Training consisted of a baseline motivational interview, advice to walk on urban trails designed for COPD patients in outdoor public spaces and other optional components for feedback, motivation, information and support (pedometer, calendar, physical activity brochure, website, phone text messages, walking groups and a phone number). The primary outcome was 12-month change in steps·day−1 measured by accelerometer. Efficacy analysis (with per-protocol analysis set, n=233 classified as adherent to the assigned intervention) showed adjusted (95% CI) 12-month difference +957 (184–1731) steps·day−1 between Urban Training and usual care. Effectiveness analysis (with intention-to-treat analysis set, n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients) showed no differences between groups. Leg muscle pain during walks was more frequently reported in Urban Training than usual care, without differences in any of the other adverse events. Urban Training, combining behavioural strategies with unsupervised outdoor walking, was efficacious in increasing physical activity after 12 months in COPD patients, with few safety concerns. However, it was ineffective in the full population including unwilling and self-reported non-adherent patients. Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patientshttp://ow.ly/dc2C30lnAEs
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Affiliation(s)
- Ane Arbillaga-Etxarri
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Physical Activity and Sports Sciences, Faculty of Psychology and Education, University of Deusto, Donostia-San Sebastián, Spain
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Respiratory Clinic Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anael Barberan-Garcia
- Respiratory Clinic Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eva Balcells
- Pompeu Fabra University (UPF), Barcelona, Spain.,Pneumology Dept, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Bunyola, Spain
| | - Marta Benet
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Eulàlia Borrell
- Sant Roc Primary Healthcare Centre, Institut Català de la Salut (ICS), Badalona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | | | - Anna Delgado
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Carme Jané
- Passeig de Sant Joan Primary Healthcare Centre, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Alicia Marin
- CIBER Respiratory Diseases (CIBERES), Bunyola, Spain.,Pneumology Dept, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlos Martín-Cantera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Passeig de Sant Joan Primary Healthcare Centre, Institut Català de la Salut (ICS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Mónica Monteagudo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Nuria Montellà
- Sant Roc Primary Healthcare Centre, Institut Català de la Salut (ICS), Badalona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Laura Muñoz
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Pilar Ortega
- Pneumology Dept, Hospital de Mataró, Mataró, Barcelona, Spain
| | - Diego A Rodríguez
- Pompeu Fabra University (UPF), Barcelona, Spain.,Pneumology Dept, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Bunyola, Spain
| | - Robert Rodríguez-Roisin
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pere Simonet
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Viladecans 2 Primary Healthcare Centre, Institut Català de la Salut (ICS), Viladecans, Spain.,University of Barcelona, Barcelona, Spain
| | - Pere Torán-Monserrat
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Jaume Torrent-Pallicer
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pere Vall-Casas
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Jordi Vilaró
- FCS Blanquerna, Global Research on Wellbeing (GRoW), Ramon Llull University, Barcelona, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Jia G, Lu M, Wu R, Chen Y, Yao W. Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China. Int J Chron Obstruct Pulmon Dis 2018; 13:3269-3280. [PMID: 30349232 PMCID: PMC6188108 DOI: 10.2147/copd.s176173] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the gender difference in knowledge, attitude, and practice of COPD diagnosis and treatment in China. PATIENTS AND METHODS A nationwide, multicenter, cross-sectional questionnaire study was carried out to investigate patients' understanding and experience of COPD between September 2007 and December 2008. RESULTS Two thousand and seventy-two patients were recruited from eleven centers. The final effective questionnaires were those of 1,698 cases, of which 32% were female. Women were younger, had higher body mass index, were more never smokers, and had lesser pack-years (all P<0.01). More women had under elementary education level and monthly income <1,000 RMB (about 160 USD) (all P<0.01). Women had higher ratio of FEV1/FVC (54.1±10.9 vs 50.2±11.5), FEV1% (50.0±19.1 vs 45.4±29.0), and lower short form-36 mental component summary (57.5±26.8 vs 61.3±25.0) (all P<0.01). Fewer women reported severe exacerbation (defined as an acute worsening of respiratory symptoms that results in patient's hospitalization) in the previous year (44.5% vs 51.6%, P<0.05). More women reported that they never heard of COPD before (67.0% vs 59.0%, P<0.01). Less women reported that physician had to tell them they had emphysema (50.5% vs 60.4%) or COPD (31.9% vs 37.9%). Less women had pulmonary function test (PFT) done before (65.2% vs 70.4%, P<0.05). More women reported that they would not repeat PFT annually (91.7% vs 87.6%, P<0.05) and did not know the PFT results (78.6% vs 73.1%, P<0.05). More women reported not having had pulmonary rehabilitation before (87.8% vs 83.6%, P<0.05). Fewer women reported knowing that COPD should be given combined therapy (38.3% vs 44.5%) and long-term treatment (46.1% vs 51.9%) (all P<0.05). CONCLUSION Male and female patients had different experiences on COPD diagnosis and treatment. Physicians should pay more attention to patients' education on COPD, especially of women.
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Affiliation(s)
- Guohua Jia
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China, ;
| | - Ming Lu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China, ;
| | - Rui Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China, ;
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China, ;
| | - Wanzhen Yao
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China, ;
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27
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Jolly K, Sidhu MS, Hewitt CA, Coventry PA, Daley A, Jordan R, Heneghan C, Singh S, Ives N, Adab P, Jowett S, Varghese J, Nunan D, Ahmed K, Dowson L, Fitzmaurice D. Self management of patients with mild COPD in primary care: randomised controlled trial. BMJ 2018; 361:k2241. [PMID: 29899047 PMCID: PMC5998171 DOI: 10.1136/bmj.k2241] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of telephone health coaching delivered by a nurse to support self management in a primary care population with mild symptoms of chronic obstructive pulmonary disease (COPD). DESIGN Multicentre randomised controlled trial. SETTING 71 general practices in four areas of England. PARTICIPANTS 577 patients with Medical Research Council dyspnoea scale scores of 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis. Patients were randomised to telephone health coaching (n=289) or usual care (n=288). INTERVENTIONS Telephone health coaching intervention delivered by nurses, underpinned by Social Cognitive Theory. The coaching promoted accessing smoking cessation services, increasing physical activity, medication management, and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). The nurses received two days of training. The usual care group received a leaflet about COPD. MAIN OUTCOME MEASURES The primary outcome was health related quality of life at 12 months using the short version of the St George's Respiratory Questionnaire (SGRQ-C). RESULTS The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of patients received all four calls. 92% of patients were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95% confidence interval -3.6 to 0.9, P=0.23). Compared with patients in the usual care group, at six months follow-up, the intervention group reported greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%), and inhaler use technique check (68% v 55%). CONCLUSIONS A new telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self management activities, but did not improve health related quality of life. TRIAL REGISTRATION Current controlled trials ISRCTN 06710391.
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Affiliation(s)
- Kate Jolly
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2ER, UK
| | - Manbinder S Sidhu
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rachel Jordan
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2ER, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sally Singh
- Centre for Exercise and Rehabilitation Science, Biomedical Research Centre (Respiratory), University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2ER, UK
| | - Susan Jowett
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2ER, UK
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jinu Varghese
- School of Education Research, University of Birmingham, Birmingham, UK
| | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Khaled Ahmed
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2ER, UK
| | - Lee Dowson
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
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