1
|
Storer B, Holden M, Kershaw KA, Braund TA, Chakouch C, Coleshill MJ, Haffar S, Harvey S, Sicouri G, Newby J, Murphy M. The prevalence of anxiety in respiratory and sleep diseases: A systematic review and meta-analysis. Respir Med 2024; 230:107677. [PMID: 38823565 DOI: 10.1016/j.rmed.2024.107677] [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: 02/20/2024] [Revised: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Anxiety is common in those with chronic physical health conditions and can have significant impacts on both quality of life and physical health outcomes. Despite this, there are limited studies comprehensively investigating the prevalence of anxiety in respiratory and sleep medicine settings. This systematic review and meta-analysis aims to provide insight into the global prevalence of anxiety symptoms/disorders in respiratory and sleep medicine outpatients. METHODS PubMed, Embase, Cochrane, PsycINFO and Google Scholar databases were searched from database inception to January 23, 2023 for studies assessing the prevalence of anxiety in adult (≥16 years) respiratory and sleep medicine outpatients. Data was screened and extracted independently by two investigators. Anxiety was measured using various self-report questionnaires, structured interviews, and/or patient records. Using CMA software for the meta-analysis, a random-effects model was used for pooled estimates, and subgroup analysis was conducted on relevant models using a mixed-effects model. RESULTS 116 studies were included, featuring 36,340 participants across 40 countries. The pooled prevalence of anxiety was 30.3 % (95%CI 27.9-32.9 %, 10,679/36,340). Subgroup analysis found a significant difference across type of condition, with pulmonary tuberculosis the highest at 43.1 % and COVID-19 outpatients the lowest at 23.4 %. No significant difference was found across anxiety types, country or age. Female sex and the use of self-report measures was associated with significantly higher anxiety estimates. CONCLUSIONS Anxiety is a common experience amongst patients in respiratory and sleep medicine outpatient settings. Thus, it is crucial that anxiety identification and management is considered by physicians in the field. REGISTRATION The protocol is registered in PROSPERO (CRD42021282416).
Collapse
Affiliation(s)
- Ben Storer
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Monique Holden
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Kelly Ann Kershaw
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Taylor A Braund
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Cassandra Chakouch
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | | | - Sam Haffar
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Samuel Harvey
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Gemma Sicouri
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, UNSW, Sydney, Australia
| | - Jill Newby
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, UNSW, Sydney, Australia
| | - Michael Murphy
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia.
| |
Collapse
|
2
|
Ho CCY, Chan CWH, Li C, Xiao J, Ng MSN. Literature review and development of pictorial action plan to promote self-management of chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 2023; 115:107923. [PMID: 37494782 DOI: 10.1016/j.pec.2023.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to review relevant literature and develop a pictorial action plan (PAP) to enhance self-management among older patients with chronic obstructive pulmonary disease (COPD). METHODS In Stage 1, an integrative review was conducted to identify key elements of respiratory self-management action plans. In Stage 2, cartoon pictograms with plain descriptions were designed. In Stage 3, the PAP was validated by 40 older patients with COPD and an expert panel. RESULTS While the eight included studies demonstrated positive effects on knowledge and quality of life, key elements identified included: traffic light motif, plain and explicit language, and several action plan topics. The final PAP comprises three traffic light-coloured zones and 24 pictograms that introduce self-management strategies for normal, decreasing, and severely decreased airflow. After revising the cartoon characters, all of the pictograms received guessability ratings above 70% and acceptable mean translucency ratings. DISCUSSION The integrative review provides evidence about the effectiveness and key elements of PAPs. The PAP developed was found to be valid and feasible for use among older patients with chronic respiratory conditions. PRACTICE IMPLICATIONS This study offered an example of translating evidence into patient education practice to enhance self-management in older patients with COPD.
Collapse
Affiliation(s)
- Cherry C Y Ho
- Division of Nursing Education, School of Continuing Education, The Hong Kong Baptist University, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
3
|
Matarese M, Lyons KS, Piredda M, De Marinis MG. Disease-related knowledge in people with chronic obstructive pulmonary disease and their informal caregivers: A multilevel modelling analysis. J Clin Nurs 2022. [PMID: 35765175 DOI: 10.1111/jocn.16433] [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: 02/06/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the level of chronic obstructive pulmonary disease (COPD)-related knowledge within patient and informal caregiver dyads, and to identify factors influencing the knowledge level considering the interdependence within the dyads. BACKGROUND Patients with COPD and their informal caregivers present poor disease knowledge and different characteristics are associated with their level of knowledge. Disease knowledge and related characteristics have been assessed separately in patients and informal caregivers, without considering possible influence within the dyads. DESIGN Cross-sectional study. METHODS A convenience sample of dyads was recruited in outpatient and inpatient settings in Central and South Italy. The Bristol COPD Knowledge Questionnaire was used to measure disease knowledge. Sociodemographic, clinical and caregiving characteristics, self-efficacy and depression were measured in patients and caregivers. Multilevel modelling was used to analyse COPD knowledge at the level of the dyad to control for interdependency between patients and informal caregivers. The STROBE guidelines for cross-sectional studies were followed for study reporting. RESULTS We recruited 133 dyads. The total level of correct knowledge shared by dyads was 32.89%. Dyads presented higher levels of correct knowledge about disease symptoms, smoking cessation and vaccination, and lower about COPD treatment. Younger patients with greater self-efficacy, who attended pulmonary rehabilitation and were cared for by a spouse/partner with low levels of depression, and informal caregivers who were patients' spouse/partner were more likely to have higher levels of disease-related knowledge. CONCLUSIONS Our study advances dyadic research in COPD. Future studies should investigate the effects of shared knowledge and incongruent knowledge (where one member knows more than the other) on patient self-care and caregiver contribution to patient self-care. RELEVANCE TO CLINICAL PRACTICE Our study shows what knowledge nurses should provide in educational programmes directed at patients and caregivers, and which dyads have greater knowledge deficits, to whom offer targeted educational interventions.
Collapse
Affiliation(s)
- Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Michela Piredda
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | | |
Collapse
|
4
|
Sloots J, Bakker M, van der Palen J, Eijsvogel M, van der Valk P, Linssen G, van Ommeren C, Grinovero M, Tabak M, Effing T, Lenferink A. Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2089-2103. [PMID: 34290502 PMCID: PMC8289298 DOI: 10.2147/copd.s299598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care. Methods In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in self-management training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro®) inhaler was used to analyze inhaled medication adherence and inhalation technique. Results In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were “call the case manager”. Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with “inhaling too shortly” (<1.25 s) being the most frequent error (79.6%). Discussion Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action “call the case manager”. Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.
Collapse
Affiliation(s)
- Joanne Sloots
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Mirthe Bakker
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands
| | - Michiel Eijsvogel
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Gerard Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands
| | - Clara van Ommeren
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Monique Tabak
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands.,Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| |
Collapse
|
5
|
Volpato E, Toniolo S, Pagnini F, Banfi P. The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2021; 16:2001-2021. [PMID: 34262270 PMCID: PMC8275112 DOI: 10.2147/copd.s313841] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes. Objective This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD. Methods English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. Results A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions. Conclusion The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.
Collapse
Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Stefania Toniolo
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Paolo Banfi
- Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| |
Collapse
|
6
|
Lee SH, Lee H, Kim YS, Park HK, Lee MK, Kim KU. Predictors of Low-Level Disease-Specific Knowledge in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1103-1110. [PMID: 32546998 PMCID: PMC7245443 DOI: 10.2147/copd.s244925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/03/2020] [Indexed: 01/07/2023] Open
Abstract
Background Disease-specific knowledge is associated with outcomes of patients, but the knowledge level of chronic obstructive pulmonary disease (COPD) patients is known to be low. Objective We measured the level of disease-specific knowledge and defined factors associated with poor disease knowledge in COPD patients. Materials and Methods A cross-sectional survey was performed in five hospitals in South Korea. At enrolment, all patients completed the Bristol COPD Knowledge Questionnaire (BCKQ), Satisfaction with Life Scale (SWLS), Personal Resource Questionnaire (PRQ), St. George’s Respiratory Questionnaire (SGRQ), 36-item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). The data were analyzed via linear regression to identify factors associated with low-level knowledge of COPD. Results A total of 245 COPD patients were enrolled in this study. The mean total BCKQ score was 28.1 (SD, 7.4). The lowest scores were seen for items exploring knowledge of “Oral steroids” and “Inhaled steroids”. In univariate analysis, higher level of education (r = 0.17), low income (r = 0.13), the post-bronchodilator FEV1, % predicted (r = −0.24), the post-bronchodilator FEV1/FVC ratio (r = −0.13), SWLS (r = 0.15), PRQ (r = 0.16), SF-36 MCS (r = 0.13), HADS-A (r = −0.17), and HADS-D (r = −0.28) scores correlated with the BCKQ score (all p < 0.05). FEV1 (r = −0.25, p < 0.001) and HADS-D score (r = −0.29, p < 0.001) were significantly associated with the total BCKQ score in multivariate analysis. Conclusion Our Korean patients with COPD lacked knowledge on oral and inhaled steroid treatments. In particular, patients with higher-level lung function and/or depressive symptoms exhibited poorer disease-specific knowledge; such patients may require additional education.
Collapse
Affiliation(s)
- Sang Hee Lee
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo-si, Republic of Korea.,Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Haejung Lee
- Department of Nursing, Pusan National University College of Nursing, Yangsan-si, Republic of Korea
| | - Yun Seong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
7
|
Jang JG, Kim JS, Chung JH, Shin KC, Ahn JH, Lee MS, Bang SH, Park DY, Nam MJ, Jin HJ, Lee KH. Comprehensive Effects of Organized Education for Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2603-2609. [PMID: 31819396 PMCID: PMC6883930 DOI: 10.2147/copd.s221673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background Despite the increasing prevalence of chronic obstructive pulmonary disease (COPD) worldwide, knowledge and awareness of COPD remain extremely low. This prospective study aimed to demonstrate the effectiveness of organized educational intervention. Patients and methods The study participants included patients diagnosed with COPD and receiving inhaler treatment. In this prospective study, the patients made three sequential visits to the hospital (baseline, 1 month, 3 months). On their first and second visits, patients received systematic education about COPD. On their first and third visits, each patient was evaluated using a COPD Assessment Test, COPD Knowledge Questionnaire, Hospital Anxiety and Depression Scale, and Rosenberg Self-Esteem Scale. Results Fifty-five participants were enrolled in the study. The mean COPD knowledge score before and after education was 12.51±3.19 and 17.89±1.37, respectively, indicating a significant increase in the score post-education (P<0.001). The measure of patients’ inhaler technique also significantly improved after education (5.40±1.50 vs 6.83±0.37 P=0.01). The rate of depression and anxiety after education decreased by 10.9% and 12.7%, respectively (P<0.001). In subgroup analysis, we compared the groups whose knowledge score increased by more than 5 points (Group B) and those whose score did not improve (Group A). In Group B, the mean CAT score significantly improved (2.61±5.88 vs −2.41±7.48, P=0.01), and the duration of their COPD diagnosis before enrollment was significantly shorter (2.72±2.43 vs 5.22±5.11 years, P=0.038) compared to those in Group A. Conclusion An organized educational program resulted in improved disease-specific knowledge. Disease-specific education is an important part of the treatment of COPD that affects the quality of life and emotional status of patients. Early education after COPD diagnosis can be beneficial.
Collapse
Affiliation(s)
- Jong Geol Jang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| | - Jee Seon Kim
- Department of Internal Medicine, Semyeong Christianity Hospital, Pohang, Republic of Korea
| | - Jin Hong Chung
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| | - Kyeong Cheol Shin
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| | - June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| | - Mi Sook Lee
- Department of Education and Management Services, Yeungnam University Medical Center,College of Medicine, Daegu, Republic of Korea
| | - So Hee Bang
- Department of Education and Management Services, Yeungnam University Medical Center,College of Medicine, Daegu, Republic of Korea
| | - Da Yeong Park
- Department of Education and Management Services, Yeungnam University Medical Center,College of Medicine, Daegu, Republic of Korea
| | - Mee Jung Nam
- Department of Education and Management Services, Yeungnam University Medical Center,College of Medicine, Daegu, Republic of Korea
| | - Hyun Jung Jin
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| | - Kwan Ho Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Daegu, Republic of Korea
| |
Collapse
|
8
|
Stamenova V, Yang R, Engel K, Liang K, van Lieshout F, Lalingo E, Cheung A, Erwood A, Radina M, Greenwald A, Agarwal P, Sidhu A, Bhatia RS, Shaw J, Shafai R, Bhattacharyya O. Technology-Enabled Self-Monitoring of Chronic Obstructive Pulmonary Disease With or Without Asynchronous Remote Monitoring: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13920. [PMID: 31429418 PMCID: PMC6718086 DOI: 10.2196/13920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. Reducing the number of COPD exacerbations is an important patient outcome and a major cost-saving approach. Both technology-enabled self-monitoring (SM) and remote monitoring (RM) programs have the potential to reduce exacerbations, but they have not been directly compared with each other. As RM is a more resource-intensive strategy, it is important to understand whether it is more effective than SM. OBJECTIVE The objective of this study is to evaluate the impact of SM and RM on self-management behaviors, COPD disease knowledge, and respiratory status relative to standard care (SC). METHODS This was a 3-arm open-label randomized controlled trial comparing SM, RM, and SC completed in an outpatient COPD clinic in a community hospital. Patients in the SM and RM groups recorded their vital signs (oxygen, blood pressure, temperature, and weight) and symptoms with the Cloud DX platform every day and were provided with a COPD action plan. Patients in the RM group also received access to a respiratory therapist (RT). The RT monitored their vital signs intermittently and contacted them when their vitals varied outside of predetermined thresholds. The RT also contacted patients once a week irrespective of their vital signs or symptoms. All patients were randomized to 1 of the 3 groups and assessed at baseline and 3 and 6 months after program initiation. The primary outcome was the Partners in Health scale, which measures self-management skills. Secondary outcomes included the St. George's Respiratory Questionnaire, Bristol COPD Knowledge Questionnaire, COPD Assessment Test, and modified-Medical Research Council Breathlessness Scale. Patients were also asked to self-report on health system usage. RESULTS A total of 122 patients participated in the study, 40 in the SC, 41 in the SM, and 41 in the RM groups. Out of those patients, 7 in the SC, 5 in the SM, and 6 in the RM groups did not complete the study. There were no significant differences in the rates of study completion among the groups (P=.80). CONCLUSIONS Both SM and RM have shown promise in reducing acute care utilization and exacerbation frequencies. As far as we are aware, no studies to date have directly compared technology-enabled self-management with RM programs in COPD patients. We believe that this study will be an important contribution to the literature. TRIAL REGISTRATION ClinicalTrials.gov NCT03741855; https://clinicaltrials.gov/ct2/show/NCT03741855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13920.
Collapse
Affiliation(s)
- Vess Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca Yang
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Katrina Engel
- Respiratory Therapy Department, Markham Stouffville Hospital, Markham, ON, Canada
| | - Kyle Liang
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Florence van Lieshout
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Elizabeth Lalingo
- Medicine, Care Transitions, Access & Flow, Respiratory Therapy, Markham Stouffville Hospital, Markham, ON, Canada
| | - Angelica Cheung
- Respiratory Therapy Department, Markham Stouffville Hospital, Markham, ON, Canada
| | - Adam Erwood
- Support Services & Transformation, Markham Stouffville Hospital, Markham, ON, Canada
| | - Maria Radina
- Centre For Respiratory Health, Markham Stouffville Hospital, Markham, ON, Canada
| | - Allen Greenwald
- Centre For Respiratory Health, Markham Stouffville Hospital, Markham, ON, Canada
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Aman Sidhu
- University Health Network, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Roshan Shafai
- Hospital to Home and Community Medical Clinic, Markham Stouffville Hospital, Markham, ON, Canada
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, ON, Canada
| |
Collapse
|
9
|
Chang YY, Dai YT. The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2019; 14:1239-1250. [PMID: 31289439 PMCID: PMC6565933 DOI: 10.2147/copd.s196592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Purpose: Self-management is widely used among patients with a chronic disease to control their condition. However, the self-management programs are less distinctive for patients with chronic obstructive pulmonary disease (COPD) than those with other chronic diseases. This study examines the efficacy of a flipping education program on improving self-management in patients with COPD. Patients and methods: A single-blinded, randomized controlled trial was conducted at a medical center in northern Taiwan from January 2015 to May 2016. Sixty participants were randomized to an experimental group and a control group. The self-management program with flipped teaching, customized action plans, and scheduled telephone interviews was implemented in the experimental group for three months. Conventional patient education was implemented in the control group. Disease knowledge, self-efficacy, the patient’s activation level, and the impact of COPD were assessed at baseline, 1 month, and 3 months after the intervention. SPSS 22.0 was used for data analysis. Results: The results showed that the patients who received the flipping education program of self-management had statistically significant improvements in their disease knowledge (p<0.05), self-efficacy (p<0.01), and activation levels (p<0.01) from baseline to the 1 month and 3 months follow-up compared to the control group. Conclusion: The findings supported that flipped teaching could be applied to patient education in adults and that a nurse case manager can feasibly use this flipping education program of self-management to motivate and support patients with COPD to acquire self-management skills, carry out their action plans, and help them achieve beneficial behaviors in their daily lives.
Collapse
Affiliation(s)
- Yi-Ya Chang
- Department of Nursing and Clinical Competency Center, Chang Gung University of Science and Technology, Taoyuan, Republic of China.,Department of Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Republic of China
| | - Yu-Tzu Dai
- School of Nursing, National Taiwan University, Taipei, Republic of China
| |
Collapse
|
10
|
Farias R, Sedeno M, Beaucage D, Drouin I, Ouellet I, Joubert A, Abimaroun R, Patel M, Abou Rjeili M, Bourbeau J. Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence. BMJ Open Respir Res 2019; 6:e000379. [PMID: 31178998 PMCID: PMC6530499 DOI: 10.1136/bmjresp-2018-000379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/20/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Self-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic. Methods Initially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients' behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases. Results Thirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001). Discussion COPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations. Trial registration number NCT02275078.
Collapse
Affiliation(s)
- Raquel Farias
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Danielle Beaucage
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Drouin
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Ouellet
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandre Joubert
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita Abimaroun
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Meena Patel
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mira Abou Rjeili
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
11
|
Schmid-Mohler G, Caress AL, Spirig R, Yorke J. Introducing a model for emotional distress in respiratory disease: A systematic review and synthesis of symptom management models. J Adv Nurs 2019; 75:1854-1867. [PMID: 30734366 DOI: 10.1111/jan.13968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
AIM To undertake a theoretical systematic review to develop a conceptual model of illness-related emotional distress in the context of symptom management in chronic respiratory disease. DESIGN We performed a systematic search to identify conceptual models. DATA SOURCES Electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO were searched and papers included from inception of the search term until June 2017. REVIEW METHODS The review was conducted following Pound and Campbell's and Turner's theory synthesis. Conceptual models were appraised using Kaplan's criteria. Models were excluded if they referred to a specific condition and/or lacked clarity. RESULTS This synthesis, which includes five models and additional evidence, yielded a new conceptual model describing the processes of regulation and symptom self-management in chronic respiratory disease. Identified sources of illness-related emotional distress are new or increased symptoms, additional treatment, new restrictions in performance of daily life roles and increased unpredictability. People goals and self-efficacy were identified as further drivers of symptom self-management. The regulation process is embedded in contextual factors. CONCLUSION Theory synthesis provided transparent guidance in developing a model to understand of the factors driving self-management decisions. Therefore, the model has the potential to guide development of interventions that support symptom self-management in chronic respiratory disease. IMPACT This newly presented conceptual model of illness-related emotional distress provides an understanding of the factors that drive self-management decisions when peoples experience new or increased symptoms. Such understanding is critical for nursing practice to developing appropriate interventions, especially in support of people decision-making.
Collapse
Affiliation(s)
| | - Ann-Louise Caress
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca Spirig
- Directorate of Nursing and Allied Health Professionals, University Hospital Zurich, Zurich, Switzerland
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
12
|
Conley P, Kelechi TJ, Nemeth LS, Mueller M. Chronic Obstructive Pulmonary Disease Discharge Education and Quality of Life Evaluation: A Feasibility Study. Res Theory Nurs Pract 2018; 32:328-348. [DOI: 10.1891/1541-6577.32.3.328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:Discharge instructions provided to hospitalized participants with chronic obstructive pulmonary disease (COPD) are essential to promote improved health outcomes, reduce incidence of hospitalization, and enhance quality of life (QOL). This study evaluated the feasibility of implementing the American Lung Association’s COPD Action Plan and assessment of QOL among participants hospitalized for acute exacerbation of COPD or COPD as a primary or secondary diagnosis.Methods:The study was conducted on a cohort of critically ill participants hospitalized on a progressive care unit. The Principal Investigator administered the WHOQOL-BREF Questionnaire to assess QOL before discharge and 30 days after discharge via phone call. Reach, Effectiveness, Adoption, Implementation, and Maintenance was used to evaluate outcomes from the discharge study.Results:Among participants enrolled (n = 50), 13 completed the in-hospital and follow-up phone call. Participants scored (12; 92% answered “yes”) that they learned appropriate COPD self-management skills, such as change in respiratory symptoms and appropriate actions to take. At 30-day follow-up: number of rehospitalizations (12; 99%), no emergency department visits, and (1; 1%) emergency department visit for insulin reaction, not COPD. Most frequent principal admitted diagnosis was acute respiratory failure, and secondary diagnosis was COPD. There was no significant difference in QOL comparing scores at discharge to 30-day follow-up, using the Wilcoxon signed-rank test.Implications for Practice:COPD education can increase participant satisfaction in receiving self-management instructions from an action plan near the time of discharge based on a small sample.
Collapse
|
13
|
Abstract
Background Although proxies of patients with chronic obstructive pulmonary disease (COPD) need health-related knowledge to support patients in managing their disease, their current level of knowledge remains unknown. We aimed to compare health-related knowledge (generic and COPD-related knowledge) between patients with COPD and their resident proxies. Methods In this cross-sectional study, we included stable patients with moderate to very severe COPD and their resident proxies (n = 194 couples). Thirty-four statements about generic health and COPD-related topics were assessed in patients and proxies separately. Statements could be answered by ‘true’, ‘false’, or ‘do not know’. This study is approved by the Medical Research Ethics Committees United (MEC-U), the Netherlands (NL42721.060.12/M12–1280). Results Patients answered on average 17% of the statements incorrect, and 19% with ‘do not know’. The same figure (19%) for the incorrect and unknown statements was shown by proxies. Patients who attended pulmonary rehabilitation previously answered more statements correct (about three) compared to patients who did not attend pulmonary rehabilitation. More correct answers were reported by: younger patients, patients with a higher level of education, patients who previously participated in pulmonary rehabilitation, patients with better cognitive functioning, and patients with a COPD diagnosis longer ago. Conclusions Proxies of patients with COPD as well as patients themselves answer about two third of 34 knowledge statements about COPD correct. So, both patients and proxies seem to have an incomplete knowledge about COPD and general health. Therefore, education about general health and COPD should be offered to all subgroups of patients with COPD and their proxies. Trial registration This study is registered in the Dutch Trial Register (NTR3941). Registered 19 April 2013.
Collapse
|
14
|
Howcroft M, Walters EH, Wood‐Baker R, Walters JAE. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 12:CD005074. [PMID: 27990628 PMCID: PMC6463844 DOI: 10.1002/14651858.cd005074.pub4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are a major driver of decline in health status and impose high costs on healthcare systems. Action plans offer a form of self-management that can be delivered in the outpatient setting to help individuals recognise and initiate early treatment for exacerbations, thereby reducing their impact. OBJECTIVES To compare effects of an action plan for COPD exacerbations provided with a single short patient education component and without a comprehensive self-management programme versus usual care. Primary outcomes were healthcare utilisation, mortality and medication use. Secondary outcomes were health-related quality of life, psychological morbidity, lung function and cost-effectiveness. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register along with CENTRAL, MEDLINE, Embase and clinical trials registers. Searches are current to November 2015. We handsearched bibliographic lists and contacted study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCT) and quasi-RCTs comparing use of an action plan versus usual care for patients with a clinical diagnosis of COPD. We permitted inclusion of a single short education component that would allow individualisation of action plans according to management needs and symptoms of people with COPD, as well as ongoing support directed at use of the action plan. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. For meta-analyses, we subgrouped studies via phone call follow-up directed at facilitating use of the action plan. MAIN RESULTS This updated review includes two additional studies (and 976 additional participants), for a total of seven parallel-group RCTs and 1550 participants, 66% of whom were male. Participants' mean age was 68 years and was similar among studies. Airflow obstruction was moderately severe in three studies and severe in four studies; mean post bronchodilator forced expiratory volume in one second (FEV1) was 54% predicted, and 27% of participants were current smokers. Four studies prepared individualised action plans, one study an oral plan and two studies standard written action plans. All studies provided short educational input on COPD, and two studies supplied ongoing support for action plan use. Follow-up was 12 months in four studies and six months in three studies.When compared with usual care, an action plan with phone call follow-up significantly reduced the combined rate of hospitalisations and emergency department (ED) visits for COPD over 12 months in one study with 743 participants (rate ratio (RR) 0.59, 95% confidence interval (CI) 0.44 to 0.79; high-quality evidence), but the rate of hospitalisations alone in this study failed to achieve statistical significance (RR 0.69, 95% CI 0.47 to 1.01; moderate-quality evidence). Over 12 months, action plans significantly decreased the likelihood of hospital admission (odds ratio (OR) 0.69, 95% CI 0.49 to 0.97; n = 897; two RCTs; moderate-quality evidence; number needed to treat for an additional beneficial outcome (NNTB) 19 (11 to 201)) and the likelihood of an ED visit (OR 0.55, 95% CI 0.38 to 0.78; n = 897; two RCTs; moderate-quality evidence; NNTB over 12 months 12 (9 to 26)) compared with usual care.Results showed no significant difference in all-cause mortality during 12 months (OR 0.88, 95% CI 0.59 to 1.31; n = 1134; four RCTs; moderate-quality evidence due to wide confidence interval). Over 12 months, use of oral corticosteroids was increased with action plans compared with usual care (mean difference (MD) 0.74 courses, 95% CI 0.12 to 1.35; n = 200; two RCTs; moderate-quality evidence), and the cumulative prednisolone dose was significantly higher (MD 779.0 mg, 95% CI 533.2 to 10248; n = 743; one RCT; high-quality evidence). Use of antibiotics was greater in the intervention group than in the usual care group (subgrouped by phone call follow-up) over 12 months (MD 2.3 courses, 95% CI 1.8 to 2.7; n = 943; three RCTs; moderate-quality evidence).Subgroup analysis by ongoing support for action plan use was limited; review authors noted no subgroup differences in the likelihood of hospital admission or ED visits or all-cause mortality over 12 months. Antibiotic use over 12 months showed a significant difference between subgroups in studies without and with ongoing support.Overall quality of life score on St George's Respiratory Questionnaire (SGRQ) showed a small improvement with action plans compared with usual care over 12 months (MD -2.8, 95% CI -0.8 to -4.8; n = 1009; three RCTs; moderate-quality evidence). Low-quality evidence showed no benefit for psychological morbidity as measured with the Hospital Anxiety and Depression Scale (HADS). AUTHORS' CONCLUSIONS Use of COPD exacerbation action plans with a single short educational component along with ongoing support directed at use of the action plan, but without a comprehensive self-management programme, reduces in-hospital healthcare utilisation and increases treatment of COPD exacerbations with corticosteroids and antibiotics. Use of COPD action plans in this context is unlikely to increase or decrease mortality. Whether additional benefit is derived from periodic ongoing support directed at use of an action plan cannot be determined from the results of this review.
Collapse
Affiliation(s)
| | - E Haydn Walters
- School of Medicine, University of TasmaniaNHMRC Centre of Research Excellence for Chronic Respiratory DiseaseHobartTasmaniaAustralia
| | | | - Julia AE Walters
- School of Medicine, University of TasmaniaMSP, 17 Liverpool StreetPO Box 23HobartTasmaniaAustralia7001
| | | |
Collapse
|