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Zhu S, Sinha D, Kirk M, Michalopoulou M, Hajizadeh A, Wren G, Doody P, Mackillop L, Smith R, Jebb SA, Astbury NM. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ 2024; 386:e078713. [PMID: 38986547 PMCID: PMC11234249 DOI: 10.1136/bmj-2023-078713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults. DESIGN Systematic review and meta-analysis. STUDY SELECTION A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined. RESULTS 129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples. CONCLUSIONS Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020219881.
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Affiliation(s)
- SuFen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deepra Sinha
- St Hugh's College, University of Oxford, Oxford, UK
| | - Megan Kirk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gina Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Doody
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Ralph Smith
- Sport and Exercise Medicine Department, Nuffield Orthopaedic Centre Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kaur A, Bourbeau J, Brighton L, Celli B, Crouch R, Demeyer H, Gerardi DA, Katsura H, Meek P, Morgan M, Paneroni M, Singh S, Stickland MK. Increasing exercise capacity and physical activity in the COPD patient. Breathe (Sheff) 2024; 20:230347. [PMID: 38873235 PMCID: PMC11167654 DOI: 10.1183/20734735.0347-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
Higher levels of exercise capacity and physical activity are desired outcomes in the comprehensive management of the COPD patient. In addition, improvements in exercise capacity and physical activity are instrumental to optimising other important therapeutic goals, such as improved health status, reduced healthcare utilisation and increased survival. Four general approaches towards increasing exercise capacity and physical activity in individuals with COPD will be discussed in this review: 1) pharmacological intervention, especially the administration of long-acting bronchodilators; 2) pulmonary rehabilitation, including exercise training and collaborative self-management; 3) behavioural interventions; and 4) web-based interventions. These are by no means the only approaches, nor are they mutually exclusive: indeed, combining them, as necessary, to meet the needs of the individual respiratory patient may promote optimal outcomes, although further research is necessary in this area.
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Affiliation(s)
- Antarpreet Kaur
- Section of Pulmonary, Interventional Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Lisa Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Bartolome Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca Crouch
- Duke University Hospital and Medical Center, Department of Physical and Occupational Therapy, Durham, NC, USA
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Daniel A. Gerardi
- Section of Pulmonary, Interventional Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Hideki Katsura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Mike Morgan
- Retired, Department of Respiratory Sciences, University of Leicester, Biomedical Research Centre, Leicester, UK
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit of the Institute of Lumezzane, Brescia, Italy
| | - Sally Singh
- Department of Respiratory Sciences, University of Leicester, Biomedical Research Centre, Leicester, UK
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and G.F. MacDonald Centre for Lung Health (Covenant Health), Edmonton, AB, Canada
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Yohannes AM. Psychosocial Support in Pulmonary Rehabilitation. Respir Care 2024; 69:664-677. [PMID: 38688547 PMCID: PMC11147630 DOI: 10.4187/respcare.11850] [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: 05/02/2024]
Abstract
Pulmonary rehabilitation (PR) improves exercise capacity and quality of life (QOL) while reducing dyspnea in patients with COPD. However, little is known about the efficacy of PR, cognitive behavioral therapy (CBT), or antidepressant drug therapy on psychosocial factors in patients with COPD. Knowledge gaps include which therapy is most efficacious, what barriers exist for each treatment, and the optimal duration of each intervention. Potential barriers to antidepressant therapy include patient fears of potential adverse effects, apprehension and misconception, and stigma related to depression. Both CBT and PR reduce anxiety and depressive symptoms in short-term studies. However, their potential benefits over medium-to-long-term follow-up and specifically on psychosocial factors warrant exploration. Furthermore, new emerging treatment strategies such as the collaborative care model and home-based telehealth coaching are promising interventions to promote patient-centered care treatment and reduce psychosocial factors adversely affecting patients with COPD. This update and critical synthesis reviews the effectiveness of both pharmacologic and non-pharmacologic interventions on psychosocial factors in patients with COPD. It also provides brief screening tools used in the assessment of anxiety and depression for patients with COPD.
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Affiliation(s)
- Abebaw Mengistu Yohannes
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama.
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Benzo RP. Self-Management Programs and the Pursuit of Behavior Change. Respir Care 2024; 69:678-685. [PMID: 38806226 PMCID: PMC11147631 DOI: 10.4187/respcare.11987] [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: 05/30/2024]
Abstract
A self-management intervention is a personalized approach to individuals aiming to engage individuals in a behavior change to develop skills to live better with their condition. Self-management involves an iterative process between participants and providers in which goals are formulated and feedback is given. All respiratory societies advocate self-management as part of chronic care because it may improve quality of life and health-care utilization. Self-management is an integral part of pulmonary rehabilitation. Self-management interventions usually involve education and exercise prescription, and that is an asset of current programs; however, recent reports indicate that effective strategies for motivation and a behavior change focus are often missed. A recent systematic review on self-management urges the need for a specific aspect and characteristic of self-management interventions: iterative interactions between participants and health-care professionals competent in using behavior change practices to elicit participants' motivation, confidence, and competence to develop skills to better manage their disease. A recent review of self-care intervention in chronic disease states that the major deficits found in self-care interventions included a lack of attention and/or innovation to the psychological consequences of chronic illness, technology, and behavior change techniques to help patients manage symptoms. There is a need for exploration of mechanisms to explain the relationships between both anxiety and depression, and adherence to treatment in COPD. The latter is particularly appropriate for pulmonary rehabilitation, for which greater adherence is needed. This report aims to introduce basic aspects of behavior change and a proposed roadmap to introduce behavior change into pulmonary rehabilitation and chronic care programs.
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Affiliation(s)
- Roberto P Benzo
- The Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota.
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Born CDC, Bhadra R, D’Souza G, Kremers SPJ, Sambashivaiah S, Schols AMWJ, Crutzen R, Beijers RJHCG. Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review. Nutrients 2024; 16:1515. [PMID: 38794757 PMCID: PMC11124109 DOI: 10.3390/nu16101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.
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Affiliation(s)
- Charlotte D. C. Born
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Rohini Bhadra
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
- Division of Clinical Physiology, St John’s Medical College & St John’s Research Institute, Bengaluru 560034, India
| | - George D’Souza
- Department of Pulmonary Medicine, St John’s Medical College Hospital, Bengaluru 560034, India
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM Institute of Nutrition and Translational Research in Metabolism, 6229 ER Maastricht, The Netherlands
| | - Sucharita Sambashivaiah
- Division of Clinical Physiology, St John’s Medical College & St John’s Research Institute, Bengaluru 560034, India
- Department of Physiology, St John’s Medical College, Bengaluru 560034, India
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 HX Maastricht, The Netherlands
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
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Benzo MV, Kelpin SS, Werneburg B, Hoult J, Clark MM, Novotny P, Benzo R. Patient Engagement in Health Coaching and Self-Management Abilities in Chronic Obstructive Pulmonary Disease. Am J Lifestyle Med 2024; 18:243-251. [PMID: 38559791 PMCID: PMC10979730 DOI: 10.1177/15598276221120523] [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: 04/04/2024] Open
Abstract
Objective: Health coaching has the potential to improve self-management abilities (SM) in patients with Chronic Obstructive Pulmonary Disease (COPD). Patient engagement with health care providers has a beneficial effect on patient outcomes. We examined the association of patient engagement with the health coach on SM abilities in patients with COPD. Methods: We analyzed the association between the degree of engagement measured by the Working Alliance Inventory (WAI-SR) and the SM measured by the Self-Management-Ability-Scale-30 (SMAS-30) at the end of a COPD health coaching intervention. Results: The cohort included 146 moderate to severe COPD patients. The WAI-SR total score was 85% of the maximum possible scores indicating a high degree of engagement between the health coach and the patients. The WAI-SR Task and Bond domains were positively associated with SM abilities after adjusting for lung function (FEV1 %) and depression symptoms (PHQ-2). Conclusion: The degree of engagement between a health coach and patients is associated with the perception of SM abilities in patients with COPD. Our results may inform self-management intervention and clinical practice.
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Affiliation(s)
- Maria V. Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Sydney S. Kelpin
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Brooke Werneburg
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Johanna Hoult
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Matthew M. Clark
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Paul Novotny
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
| | - Roberto Benzo
- Mindful Breathing Lab, Mayo Clinic, Rochester, MN, USA (MVB, JH, RB); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA (SSK, MMC); Patient Experience-Training, Education & Coaching, Mayo Clinic, Rochester, MN, USA (BW); and Research Services, Mayo Clinic, Rochester, MN, USA (PN)
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7
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Federman AD, O’Conor R, Nnemnbeng J, Ankam J, McDermott D, Lindenauer PK, Wolf MS, Wisnivesky JP. Feasibility Trial of a Comprehensive, Highly Patient-Centered COPD Self-Management Support Program. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:13-25. [PMID: 37813826 PMCID: PMC10913921 DOI: 10.15326/jcopdf.2023.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
Purpose To test the feasibility of a novel self-management support intervention for people with chronic obstructive pulmonary disease (COPD). Methods We conducted a feasibility randomized controlled trial involving patients ≥40 years with severe or very severe COPD in New York, New York (n=59). Community health workers screened patients and addressed barriers to COPD self-management. Patients were also offered home-based pulmonary rehabilitation (HBPR) and an antibiotic and steroid rescue pack. Control patients received general COPD education. Clinical outcomes for intervention and control were compared by difference-in-differences (DiD) at baseline and 6 months. The study was not powered for statistically significant differences for any measure. Feasibility measures were collected at 6 months. Results There were high rates of completion of intervention activities, including 75% of patients undergoing evaluation for and participating in HBPR. Most (92%) intervention patients said the program was very or extremely helpful and 96% said they would participate again. Clinical outcomes generally favored the intervention: COPD assessment test, DiD -1.1 (95% confidence interval [CI] -5.9 to 3.6); 6-minute walk test distance, DiD 7.4 meters (95% CI -45.1 to 59.8); self-reported hospitalizations, DiD -9.8% (95% CI -42.3% to 22.8%); medication adherence, DiD 7.7% (-29.6%, 45.0%), and Physical Activity Adult Questionnaire, DiD 86 (95% CI -283 to 455). Intervention patients reported more emergency department visits, DiD 10.6% (95% CI 17.7% to 38.8%). Conclusions A highly patient-centered, self-management support intervention for people with COPD was well received by patients and associated with potential improvements in clinical and self-management outcomes. A fully powered study of the intervention is warranted.
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Affiliation(s)
- Alex D. Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Rachel O’Conor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, New York, New York, United States
| | - Jeannys Nnemnbeng
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts, United States
| | - Michael S. Wolf
- Department of Medicine, Feinberg School of Medicine, Northwestern University, New York, New York, United States
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 117:107975. [PMID: 37738790 PMCID: PMC10964774 DOI: 10.1016/j.pec.2023.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Health and Wellness Coaching (HWC) may be beneficial in chronic condition care. We sought to appraise its effectiveness on quality of life (QoL), self-efficacy (SE), depression, and anxiety. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL for randomized trials published January 2005 - March 2023 that compared HWC to standard clinical care or another intervention without coaching. We examined QoL, SE, depression, or anxiety outcomes. Meta-analysis utilizing the random-effects model was used to estimate the pooled standardized mean difference (SMD). RESULTS Thirty included studies demonstrated that HWC improved QoL within 3 months (SMD 0.62 95 % CI 0.22-1.02, p = 0.002), SE within 1.5 months (SMD 0.38, 95 % CI 0.03-0.73, p = 0.03), and depression at 3, 6, and 12 months (SMD 0.67, 95 % CI 0.13-1.20, p = 0.01), (SMD 0.72, 95 % CI 0.19-1.24, p = 0.006), and (SMD 0.41, 95 % CI 0.09-0.73, p = 0.01) Certainty in the evidence for most outcomes was either very low or low primarily due to the high risk of bias, heterogeneity, and imprecision. CONCLUSION HWC improves QoL, SE, and depression across chronic illness populations. Future research needs to standardize intervention reporting and outcome collection. PRACTICE IMPLICATIONS Future HWC studies should standardize intervention components, reporting, and outcome measures, apply relevant chronic illness theories, and aim to follow participants for greater than one year.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Neri A Álvarez-Villalobos
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico; School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Suzette Barakat
- Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Humberto de Leon-Gutierrez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Fernando G Ruiz-Hernandez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | - Héctor Vaquera-Alfaro
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Sangwoo Ahn
- University of Tennessee Knoxville, Knoxville, TN, USA.
| | | | - Michael R Gionfriddo
- Department of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA.
| | - Juan M Millan-Alanis
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | | | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Zhen Wang
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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Vázquez-Calatayud M, Olano-Lizarraga M, Quesada-Melero AM, Rumeu-Casares C, Saracíbar-Razquin M, Paloma-Mora B. Nursing capacity building in health coaching with hospitalised chronic heart failure patients: a quasi-experimental study. Contemp Nurse 2023; 59:443-461. [PMID: 37751247 DOI: 10.1080/10376178.2023.2262612] [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] [Received: 11/03/2022] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Difficulty in adherence to treatment and self-care behaviours is a leading cause of preventable readmission in people with chronic heart failure (CHF). Although there is evidence of benefits of health coaching for the management of this situation, few interventions have been tested in the hospital setting. AIM To evaluate a coaching programme (H-Coaching) designed to develop nursing capacity in health coaching for chronic heart failure inpatients. METHODS A quasi-experimental pre-post study including all nurses in a single centre cardiology ward (N = 19). The intervention consisted of two training packages: (1) five theoretical-practical sessions on health-coaching competencies, emotional intelligence, communication and support of chronic heart failure patients in their illness in the hospital setting; and (2) training sessions seven months after the first training package to reinforce the theoretical and practical knowledge. On four occasions, the Competence Instrument of Health Education for the Nursing professional was used to measure nurses' knowledge, skills and attitudes in health coaching for chronic heart failure patients. RESULTS The difference between the preintervention and postintervention scores were statistically significant for knowledge [mean difference = 1.00 (95% CI -1.45 to -0.51; p = 0.000)], skills in general [mean difference = 0.50 (95% CI -1.41 to -0.21; p = 0.015)] and personal/social skills [mean difference = 1.00 (95% CI -1.10 to -0.01; p = 0.048)]. While attitudinal and affective domains did not differ, there were differences in knowledge and skills. CONCLUSION The H-Coaching programme proved to be effective for building nursing capacity in health coaching CHF inpatients. Similar programmes designed to improve knowledge in verbal and nonverbal communication techniques, and skills for coaching interventions adapted to meet the needs of individual patients, should be tested in future interventional experimental studies. CLINICAL TRIAL REGISTRATION NUMBER NCT05300880. IMPACT STATEMENT To our knowledge, this is the first nursing training intervention in health coaching for chronic heart failure the inpatient setting. This study has demonstrate improvements in both the knowledge and personal and social skills of cardiology nurses with regard to the development of health coaching in a hospital setting. Given the study design, further research is warranted. PLAIN LANGUAGE SUMMARY Many patients with chronic heart failure have problems in adhering to the treatment and self-care behaviours and this is one of the main causes of preventable readmission. To promote self-care, patients need to be empowered to integrate these habits into their daily lives and we should implement innovative strategies to achieve this. Health coaching is an ideal alternative to this but very few nurses in the hospital cardiology setting are experienced in health coaching. Our study has shown preliminary results demonstrating that a structured theoretical and practical training programme for nurses can improve nurses' knowledge and skills in health coaching for inpatient patients with chronic heart failure. This study provides an opportunity for future research to demonstrate whether nurses with this training have a positive impact on the health outcomes of chronic heart failure patients and, more specifically, on their levels of self-care and empowerment.
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Affiliation(s)
- Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Maddi Olano-Lizarraga
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | | | - Carmen Rumeu-Casares
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- School of Nursing, Universidad de Navarra, Campus Universitario, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
- Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Beatriz Paloma-Mora
- Clínica Universidad de Navarra, Avda. Pío XII 36, 31008 Pamplona, Spain
- University of Navarra, Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Pamplona, Spain
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10
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Willard-Grace R, Hessler D, Huang B, DeVore D, Chirinos C, Wolf J, Low D, Garvey C, Donesky D, Tsao S, Thom DH, Su G. Pulmonary Specialist-Supported Health Coaching Delivered by Lay Personnel Improves Receipt of Quality Care for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. J Patient Cent Res Rev 2023; 10:201-209. [PMID: 38046991 PMCID: PMC10688918 DOI: 10.17294/2330-0698.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting. Methods As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care. Results Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P=0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P=0.04) and educational classes (increase of 5.3% over usual care; P=0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P=0.06). Conclusions Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Beatrice Huang
- Division of HIV, Infectious Disease and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Denise DeVore
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Devon Low
- independent consultant
- patient research partner
| | | | - DorAnne Donesky
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA
| | - David H. Thom
- Primary Care and Population Health, Stanford University, Stanford, CA
| | - George Su
- Division of Pulmonology, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA
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11
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Chow R, So OW, Im JHB, Chapman KR, Orchanian-Cheff A, Gershon AS, Wu R. Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2581-2617. [PMID: 38022828 PMCID: PMC10664718 DOI: 10.2147/copd.s418295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. Methods A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). Results In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. Conclusion The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
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Affiliation(s)
- Ronald Chow
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia W So
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth R Chapman
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Wu
- University Health Network, University of Toronto, Toronto, ON, Canada
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12
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Meneses-Echavez JF, Chavez Guapo N, Loaiza-Betancur AF, Machado A, Bidonde J. Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review. Respir Med 2023; 219:107425. [PMID: 37858727 DOI: 10.1016/j.rmed.2023.107425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). MATERIAL AND METHODS We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach. RESULTS This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence). CONCLUSION Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence. REGISTRATION The study protocol was registered in Open Science Framework (https://osf.io/amgbz/).
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Affiliation(s)
- Jose F Meneses-Echavez
- Norwegian Institute of Public Health, Oslo, Norway; Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
| | - Nathaly Chavez Guapo
- Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
| | - Andrés Felipe Loaiza-Betancur
- Instituto Universitario de Educación Física, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para La Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia.
| | - Ana Machado
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.
| | - Julia Bidonde
- Norwegian Institute of Public Health, Oslo, Norway; School of Rehabilitation Sciences, University of Saskatchewan, Canada.
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13
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Chahdi M, Bruchhäuser A, von Gahlen-Hoops W, Nydahl P. [Interventions to reduce hospital readmission rates in patients with COPD: a systematic review]. Med Klin Intensivmed Notfmed 2023; 118:584-591. [PMID: 37099147 DOI: 10.1007/s00063-023-01003-0] [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] [Received: 12/31/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a high risk of hospital and intensive care unit readmission. Readmissions are a severe burden on patients, families, and the health care system. The aim of this study is to identify pedagogical-counseling interventions to reduce readmissions and other parameters in COPD patients. METHODS A systematic literature search was performed in March 2022 in the databases Medline, Cochrane Library, CINAHL, and LIVIVO. German‑, English‑, Arabic-, and French-language (cluster-) randomized, controlled studies were included. RESULTS In all, 21 studies with a total of 3894 COPD patients were included. The quality of included studies was moderate to good. Interventions were self-management programs, telemedical, and educational interventions. Five out of seven studies found a significant reduction in readmissions for self-management programs (p = 0.02-0.49). A positive effect of telemedicine interventions on outcome parameters was only reported in two studies (p < 0.05) and no significant effect in four studies. Educational interventions were examined in six studies: four found no difference between the study groups and two found a significant difference in favor of the intervention group (p = 0.01). Special care programs also showed a significant effect in two studies. CONCLUSION
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Affiliation(s)
- Mohamed Chahdi
- Gesundheits- und Krankenpfleger, Klinik für Neurologie, Station D110, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland, Arnold-Heller-Str. 3.
| | - Antje Bruchhäuser
- Gesundheits- und Krankenpflegerin, Weaning-Station, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Wolfgang von Gahlen-Hoops
- Professur für Didaktik der Pflege und Gesundheitsberufe, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Peter Nydahl
- Arbeitsgruppe Didaktik in der Pflege, Pflegewissenschaft und -entwicklung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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14
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Midthun WR, Benzo MV, Ridgeway JL, Benzo RP. Understanding the Patient Experience of Home-Based Pulmonary Rehabilitation with Health Coaching for COPD: A Qualitative Interview Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:224-233. [PMID: 37140957 PMCID: PMC10484487 DOI: 10.15326/jcopdf.2022.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 05/05/2023]
Abstract
Background We recently reported on a randomized trial of home-based pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) that showed improvement in all domains of quality of life, accelerometry-measured physical activity, and self-management. In this current study, we used a theoretical framework to help us gain an in-depth understanding of how patients experience complex, multi-component programs to help uncover factors related to behavior change and to inform program scale-up in other populations. Study Design and Methods The parent trial was conducted with COPD patients receiving care at an academic medical center and a community health system in the upper Midwest. The 12-week PR intervention included 3 daily video-guided exercises, activity monitors, and weekly telephonic health coaching. Trial participants were eligible to participate in an individual phone interview about their experience if they completed the intervention within the prior 12 months.. Analysis of verbatim transcripts followed an inductive thematic approach followed by deductive categorization and interpretation using a theoretical model: the Capability, Opportunity, Motivation-Behavior (COM-B) model developed for linking intervention functions to aspects of behavioral change. Results Among 32 eligible program participants,32 were approached, and 15 completed interviews between October 19, 2021, and January 13, 2022. The COM-B model and recommendations for program improvement were observed in the primary findings. Discussion Participants' feedback highlighted how the health coaching bolstered skills and confidence among individuals with the poorest function at program enrollment and how improved physical function and mood led to motivation. It also highlighted the roles of technology and telephonic support in a home-based program. Suggestions for improvement included providing exercise variations.
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Affiliation(s)
- William R Midthun
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria V Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States
| | - Roberto P Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
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15
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Veroniki AA, Soobiah C, Nincic V, Lai Y, Rios P, MacDonald H, Khan PA, Ghassemi M, Yazdi F, Brownson RC, Chambers DA, Dolovich LR, Edwards A, Glasziou PP, Graham ID, Hemmelgarn BR, Holmes BJ, Isaranuwatchai W, Legare F, McGowan J, Presseau J, Squires JE, Stelfox HT, Strifler L, Van der Weijden T, Fahim C, Tricco AC, Straus SE. Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions. BMC Med 2023; 21:269. [PMID: 37488589 PMCID: PMC10367354 DOI: 10.1186/s12916-023-02966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084810.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO USA
| | - David A. Chambers
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD USA
| | - Lisa R. Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada
- Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON Canada
| | - Annemarie Edwards
- Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON Canada
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226 Australia
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB 2J2.00 Canada
| | - Bev J. Holmes
- The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - France Legare
- Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC Canada
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Janet E. Squires
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
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16
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Duke JD, Moua T, Ridgeway JL, Roy M, Benzo M, Hoult J, Benzo R. Home-Based Pulmonary Rehabilitation and Health Coaching in Fibrotic Interstitial Lung Disease: IMPLEMENTATION AND QUALITATIVE ASSESSMENT OF A PILOT TELEHEALTH PROGRAM. J Cardiopulm Rehabil Prev 2023; 43:270-276. [PMID: 36728336 PMCID: PMC10290571 DOI: 10.1097/hcr.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Pulmonary rehabilitation is a behavioral modification intervention shown to improve exercise tolerance and patient-reported quality of life in patients with fibrotic interstitial lung disease. Home-based rehabilitation may provide easier access for those who struggle to complete center-based rehabilitation programs due to increased symptom burden or frailty. METHODS We present the quantitative and qualitative findings of a pilot study of 21 patients with fibrotic interstitial lung disease who participated in a 12-wk home-based pulmonary rehabilitation program with activity monitoring and health coaching. RESULTS Pre- and post-intervention patient-reported outcome questionnaires suggested improvements in dyspnea and respiratory-related quality of life but were underpowered to meet statistical significance. Half had increases in mean daily step counts while a quarter declined because of disease progression. Qualitative analysis of semistructured participant interviews suggested a significant baseline disease burden with related secondary impacts, including anxiety regarding disease progression and prognosis. Many who participated had no specific program expectations or self-determined goals but still found the program impactful, particularly on their abilities to adapt and cope with the disease. CONCLUSION Our study suggests feasibility in a diverse set of patients with varying severity and diagnostic subtypes. We also provide quantitative and qualitative aspects of program impact on patient well-being and highlight the complex interaction between measured physical and self-reported outcomes and disease experience.
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Affiliation(s)
- Jennifer D. Duke
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer L. Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Madison Roy
- Department of Statistics, Mayo Clinic, Rochester, MN
| | - Maria Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Johanna Hoult
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Roberto Benzo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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17
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Minga I, Balasubramanian S, Adum JPS, Kwak E, Macrinici V. Personalized Postacute Hospitalization Recovery: A Novel Intervention to Improve Patient Experience and Reduce Cost. J Healthc Manag 2023; 68:284-297. [PMID: 37326622 PMCID: PMC10298184 DOI: 10.1097/jhm-d-22-00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
GOAL Readmissions are a significant financial burden for payers. Cardiovascular-related discharges are particularly prone to readmission. Posthospital discharge support can impact patient recovery and probably reduce patient readmissions. This study aimed to address the underlying behavioral and psychosocial factors that can negatively affect patients after discharge. METHODS The study population was adult patients admitted to the hospital with a cardiovascular diagnosis who had a plan to discharge home. Those who consented to participate were randomized to intervention or control groups on a 1:1 basis. The intervention group received behavioral and emotional support, whereas the control group received usual care. Interventions included motivational interviewing, patient activation, empathetic communication, addressing mental health and substance use, and mindfulness. PRINCIPAL FINDINGS Observed total readmission costs were significantly lower in the intervention group than in the control group ($1.1 million vs. $2.0 million) as was the observed mean cost per readmitted patient ($44,052 vs. $91,278). The mean expected cost of readmission after adjustment for confounding variables was lower in the intervention group than in the control group ($8,094 vs. $9,882, p = .011). PRACTICAL APPLICATIONS Readmissions are a costly spend category. In this study, posthospital discharge support addressing the psychosocial factors contributing to patients' readmissions resulted in a lower total cost of care for those with a cardiovascular diagnosis. We describe an intervention that is reproducible and can be scaled broadly through technology to reduce readmission costs.
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Affiliation(s)
- Iva Minga
- For more information, contact Dr. Minga at
| | | | | | | | - Victor Macrinici
- NorthShore University HealthSystem, Evanston, Illinois and The University of Chicago, Pritzker School of Medicine, Chicago Illinois
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18
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Park Y, Kim J, Kim S, Moon D, Jo H. Effects of Transitional Care after Hospital Discharge in Patients with Chronic Obstructive Pulmonary Disease: An Updated Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6053. [PMID: 37297657 PMCID: PMC10253211 DOI: 10.3390/ijerph20116053] [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: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
This study aimed to systematically review the effects of transitional care programs on healthcare use and quality of life in patients with chronic obstructive pulmonary disease (COPD). Several databases were searched for randomized controlled trials conducted over the past five years, and their quality was evaluated using the Cochrane Risk of Bias 2.0 tool. For indicators with available statistical information, a meta-analysis was performed using RevMan 5.4, and a narrative review was performed for the rest of the results. In the meta-analysis, no statistically significant difference was observed between the intervention and control groups in the number of readmissions and emergency room visits due to COPD. The relative risk (RR) of readmission for COPD was lower in the intervention group. Respiratory-related quality of life tended to be better in the intervention group, though not significantly. Physical capacity was improved in the intervention group. Considering the characteristics of the complex intervention, the context and factors of cases where the expected results could be obtained and cases where the expected results could not be obtained were reviewed and discussed. Based on the results of the analysis, implications for the development of better protocols were presented.
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Affiliation(s)
- Yukyung Park
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Jiwon Kim
- Department of Elderly Clinical Counseling, Seoul Graduate School of Counseling Psychology, Seoul 03136, Republic of Korea
| | - Sukyoung Kim
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
| | - Dahae Moon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Heuisug Jo
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon 24341, Republic of Korea
- Division of Public Health, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
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19
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 141] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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20
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Arch Bronconeumol 2023; 59:232-248. [PMID: 36933949 DOI: 10.1016/j.arbres.2023.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain.
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK; School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga A Wedzicha
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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21
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, de Oca MM, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, Varela MVL, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Respirology 2023; 28:316-338. [PMID: 36856440 DOI: 10.1111/resp.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute Imperial College London, UK
| | - Jean Bourbeau
- McGill University Health Centre McGill University Montreal, Canada
| | - MeiLan K Han
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando J Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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22
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Rojas JC, Chokkara S, Zhu M, Lindenauer PK, Press VG. Care Quality for Patients with Chronic Obstructive Pulmonary Disease in the Readmission Penalty Era. Am J Respir Crit Care Med 2023; 207:29-37. [PMID: 35916652 PMCID: PMC9952855 DOI: 10.1164/rccm.202203-0496oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is the fifth-leading cause of admissions and third-leading cause of readmissions among U.S. adults. Recent policies instituted financial penalties for excessive COPD readmissions. Objectives: To evaluate changes in the quality of care for patients hospitalized for COPD after implementation of the Hospital Readmissions Reduction Program (HRRP). Methods: We conducted a retrospective cohort study of patients older than 40 years of age hospitalized for COPD across 995 U.S. hospitals (Premier Healthcare Database). Measurements and Main Results: Quality of care before and after HRRP implementation was measured via adherence to recommended inpatient care treatments for acute exacerbations of COPD (recommended care, nonrecommended care, "ideal care" [all recommended and no nonrecommended care]). We included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions. Recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP (P < 0.001). Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP (P < 0.001). Conclusions: The pre-HRRP trends toward improving care quality for inpatient COPD care slowed after HRRP implementation. This suggests that financial penalties for readmissions did not stimulate higher quality of care for patients hospitalized with COPD. It remains unclear what policies or approaches will be effective to ensure high care quality for patients hospitalized with COPD exacerbations.
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Affiliation(s)
- Juan C. Rojas
- Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - Sukarn Chokkara
- Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School – Baystate, Springfield, Massachusetts
| | - Valerie G. Press
- Department of Medicine, University of Chicago, Chicago, Illinois; and
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23
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Wang C, Liu K, Sun X, Yin Y, Tang T. Effectiveness of motivational interviewing among patients with COPD: A systematic review with meta-analysis and trial sequential analysis of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2022; 105:3174-3185. [PMID: 35927110 DOI: 10.1016/j.pec.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of motivational interviewing (MI) for COPD in behavioral changes and health outcomes, and also verify the reliability of results in conjunction with trial sequential analysis and the Grading of Recommendations Assessment, Development, and Evaluation tool. METHODS Studies that implemented MI interventions for COPD patients were systematically searched by eight databases from inception to December 2021. Study screening, quality assessment, data extraction, and meta-analysis were conducted according to Cochrane standards. RESULTS Twenty-one studies involving 2344 patients were included. The results of meta-analyses indicated that MI made significant improvement in self-efficacy, lung function, quality of life, emotion, and COPD-related admission, but not in self-management and exercise capacity. Subgroup analyses found that the intervention duration was inversely associated with effect size for both self-efficacy and negative emotion severity. The trial sequential analysis showed MI improved patients' lung function and reduced COPD-related hospitalization with certainty, but the findings for exercise capacity need to be confirmed by further research. CONCLUSIONS This systematic review suggested the positive effects of MI on self-efficacy, lung function, quality of life, emotion and COPD-related hospitalization. To make a firm conclusion, more well-designed clinical trials with bigger sample sizes required. PRACTICE IMPLICATIONS Clinical and community nurses can use MI for COPD to increase healthy behaviors. TRIAL REGISTRATION CRD42021278674.
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Affiliation(s)
- Chen Wang
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Kouying Liu
- School of Nursing, Nanjing Medical University, Nanjing, China; Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Xiaohui Sun
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Ting Tang
- Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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24
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Benzo R, Hoult J, McEvoy C, Clark M, Benzo M, Johnson M, Novotny P. Promoting Chronic Obstructive Pulmonary Disease Wellness through Remote Monitoring and Health Coaching: A Clinical Trial. Ann Am Thorac Soc 2022; 19:1808-1817. [PMID: 35914215 PMCID: PMC9667800 DOI: 10.1513/annalsats.202203-214oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: Quality of life (QoL) matters the most to patients with chronic obstructive pulmonary disease (COPD) and is associated with healthcare usage and survival. Pulmonary rehabilitation is the most effective intervention in improving QoL but has low uptake and adherence. Home-based programs are a proposed solution. However, there is a knowledge gap on effective and sustainable home-based programs impacting QoL in patients with COPD. Objectives: To determine whether remote patient monitoring with health coaching improves the physical and emotional disease-specific QoL measured by the Chronic Respiratory Questionnaire (CRQ). Methods: This multicenter clinical trial enrolled 375 adult patients with COPD, randomized to a 12-week remote patient monitoring with health coaching (n = 188) or wait-list usual care (n = 187). Primary outcomes include physical and emotional QoL measured by the CRQ summary scores. Prespecified secondary outcomes included the CRQ domains: dyspnea, CRQ-fatigue, CRQ-emotions, CRQ-mastery, daily physical activity, self-management abilities, symptoms of depression/anxiety, emergency room/hospital admissions, and sleep. Results: Participant age: 69 ± 9 years; 59% women; forced expiratory volume in 1 second percent predicted: 45 ± 19. At 12 weeks, there was a significant and clinically meaningful difference between the intervention versus the control group in the physical and emotional CRQ summary scores: change difference (95% confidence interval): 0.54 points (0.36-0.73), P < 0.001; 0.51 (0.39-0.69), P < 0.001, respectively. In addition, all CRQ domains, self-management, daily physical activity, sleep, and depression scores improved (P < 0.01). CRQ changes were maintained at 24 weeks. Conclusions: Remote monitoring with health coaching promotes COPD wellness and behavior change, given its effect on all aspects of QoL, self-management, daily physical activity, sleep, and depression scores. It represents an effective option for home-based rehabilitation. Clinical trial registered with clinicaltrials.gov (NCT03480386).
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Affiliation(s)
- Roberto Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Johanna Hoult
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Charlene McEvoy
- Health Partners Research Foundation, Saint Paul, Minnesota; and
| | | | - Maria Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine
| | - Margaret Johnson
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Jacksonville, Florida
| | - Paul Novotny
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
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25
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Borge CR, Larsen MH, Osborne RH, Engebretsen E, Andersen MH, Holter IA, Wahl AK. How to co-design a health literacy-informed intervention based on a needs assessment study in chronic obstructive pulmonary disease. BMJ Open 2022; 12:e063022. [PMID: 36302571 PMCID: PMC9621159 DOI: 10.1136/bmjopen-2022-063022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop a co-designed health literacy (HL)-informed intervention for people with chronic obstructive pulmonary disease (COPD) that enables them to find, understand, remember, use and communicate the health information needed to promote and maintain good health. DESIGN This study used a co-design approach informed by the programme logic of the Ophelia (Optimising Health Literacy and Access) process. The co-design included workshops where possible solutions for an HL-informed intervention were discussed based on an HL needs assessment study. SETTINGS Five workshops were performed in a local community setting in the specialist and municipality healthcare services in Oslo, Norway. PARTICIPANTS People with COPD, multidisciplinary healthcare professionals (HCPs) from the municipality and specialist healthcare services, and researchers (n=19) participated in the workshops. The co-designed HL-informed intervention was based on seven focus groups with people with COPD (n=14) and HCPs (n=21), and a cross-sectional study of people with COPD using the Health Literacy Questionnaire (n=69). RESULTS The workshop co-design process identified 45 action points and 51 description points for possible intervention solutions to meet the HL needs of people with COPD. The final recommendation for an HL-informed intervention focused on tailored follow-up after hospitalisation, which uses motivational interviewing techniques, is based on the individual's HL, self-management and quality of life needs and is implemented in cooperation with HCPs in both the specialist and municipality healthcare services. CONCLUSION During the codesign process, the workshop group generated several ideas for how to help patients find, understand, remember, use and communicate health information in order to promote and maintain good health. People with COPD need tailored follow-up based on their individual HL needs by HCPs that have knowledge of COPD and are able to motivate them for self-management tasks and help them to improve their quality of life (QOL) and decrease hospitalisation.
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Affiliation(s)
- Christine Råheim Borge
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Research Department, Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Marit Helen Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
- Division of Cancer Medicine, Surgery and Transplantation, Oslo Universitetssykehus, Oslo, Norway
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo Faculty of Medicine, Oslo, Norway
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26
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Dabscheck E, George J, Hermann K, McDonald CF, McDonald VM, McNamara R, O’Brien M, Smith B, Zwar NA, Yang IA. COPD‐X
Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update. Med J Aust 2022; 217:415-423. [DOI: 10.5694/mja2.51708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Johnson George
- Centre for Medicine Use and Safety Monash University Melbourne VIC
| | | | | | | | - Renae McNamara
- Prince of Wales Hospital and Community Health Services Sydney NSW
| | | | | | | | - Ian A Yang
- University of Queensland Brisbane QLD
- Prince Charles Hospital Brisbane QLD
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27
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Gogou E, Hatzoglou C, Zarogiannis SG, Siachpazidou D, Gerogianni I, Kotsiou OS, Varsamas C, Gourgoulianis KI. Are younger COPD patients adequately vaccinated for influenza and pneumococcus? Respir Med 2022; 203:106988. [PMID: 36162248 DOI: 10.1016/j.rmed.2022.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022]
Abstract
Influenza and pneumococcal pneumonia are major causes of increased morbidity and mortality among elderly and COPD patients. Vaccines against influenza and pneumococcus are recommended for COPD patients according to GOLD 2020 guidelines to prevent serious illnesses. Despite their high morbidity and mortality burden, the vaccination coverage rates remain far below the WHO's recommended targets. In Greece, there are insufficient data on influenza and pneumococcal immunization rates among younger COPD patients. This study investigated whether COPD patients under the age of 65 are adequately vaccinated against influenza and pneumococcus and the factors that influence vaccination rates. 1100 individuals at 22 Primary Health Centers in Central Greece participated in a two-year spirometry monitoring program. Face-to-face interviews were used to collect information regarding demographics, smoking status, comorbidities, respiratory illnesses in the previous two years, and influenza and pneumococcal vaccination coverage from all COPD patients. 117 patients aged 40-65 years old were diagnosed with COPD and 80.3% were males. Only 40.2% of them had received influenza and 32.5% pneumococcus vaccinations. Age, advanced stage of COPD, years on COPD diagnosis, respiratory infection within the previous two years, comorbidity, and smoking cessation are all positively connected with influenza and pneumococcus vaccine coverage in younger COPD patients. Gender, education level, and marital status did not affect influenza and pneumococcus vaccination rates. These vaccination rates among younger COPD patients demonstrate the need for increased awareness and knowledge about the advantages of immunizations in lowering morbidity and mortality.
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Affiliation(s)
- Evdoxia Gogou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Chryssi Hatzoglou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Dimitra Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Irini Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
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28
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Borge CR, Larsen MH, Osborne RH, Engebretsen E, Andersen MH, Holter IA, Leine M, Wahl AK. Exploring patients' and health professionals' perspectives on health literacy needs in the context of chronic obstructive pulmonary disease. Chronic Illn 2022; 18:549-561. [PMID: 33705224 DOI: 10.1177/1742395321999441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Persons with chronic obstructive pulmonary disease (COPD) require complex follow-up by healthcare professionals (HCPs) and may experience several health literacy (HL) needs. This study aimed to explore such needs in people with COPD and the HCPs who care for them. METHODS From October 2016 to August 2017 a qualitative study with four focus groups (FG) were performed in people with COPD (n = 14) and three in multidisciplinary HCPs (n = 21). An inductive thematic analysis was used to investigate HL needs. RESULTS Four HL needs emerged: 1) strengthening the feeling of security; 2) combating the burden of insufficient knowledge on COPD and lack of informational flow; 3) supporting motivation for endurance and self-management; and 4) strengthening dignity. DISCUSSION This study highlights a gap between people with COPD who express important HL needs and HCPs' capabilities to care for these needs. For HCPs to increase HL in such cases, HCPs need to improve their own HL. It is essential to find solutions on how to improve HL in HCPs who care for people with COPD and to increase the availability of interventions that increase HL in COPD. Education programs, health organizations, and governments should be aware of HL needs in such situations.
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Affiliation(s)
- Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Eivind Engebretsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Marit H Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.,Oslo University Hospital, Oslo, Norway
| | | | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
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Atwood CE, Bhutani M, Ospina MB, Rowe BH, Leigh R, Deuchar L, Faris P, Michas M, Mrklas KJ, Graham J, Aceron R, Damant R, Green L, Hirani N, Longard K, Meyer V, Mitchell P, Tsai W, Walker B, Stickland MK. Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator. Chest 2022; 162:321-330. [DOI: 10.1016/j.chest.2022.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022] Open
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Valery PC, Bernardes CM, Hayward KL, Hartel G, Haynes K, Gordon LG, Stuart KA, Wright PL, Johnson A, Powell EE. Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study. BMC Gastroenterol 2022; 22:340. [PMID: 35836105 PMCID: PMC9284723 DOI: 10.1186/s12876-022-02407-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/29/2022] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Optimal management of cirrhosis is complex, and patients often lack knowledge and skills, which can affect self-management. We assessed patient knowledge about cirrhosis and examined whether knowledge was associated with clinical outcomes, healthcare service use, and healthcare costs. A cross-sectional 'knowledge survey' was conducted during 2018-2020. We assessed patient knowledge about cirrhosis and explore whether knowledge was associated with clinical outcomes, healthcare service use, and costs. METHODS Patients with cirrhosis (n = 123) completed a 'knowledge survey'. We calculated the proportion of correct answers to eight questions deemed to be "key knowledge" about cirrhosis by an expert panel, and dichotomized patients as 'good knowledge'/'poor knowledge'. Clinical data, healthcare costs, and health-related quality of life (SF-36) were available. RESULTS 58.5% of patients had 'good knowledge' about cirrhosis. Higher education level was associated with higher odds of having 'good knowledge' about cirrhosis (adjusted-OR = 5.55, 95%CI 2.40-12.84). Compared to patients with 'poor knowledge', those with 'good knowledge' had a higher health status in the SF-36 physical functioning domain (p = 0.011), fewer cirrhosis-related admissions (adjusted incidence rate ratio [IRR] = 0.59, 95%CI 0.35-0.99) and emergency presentations (adj-IRR = 0.34, 95%CI 0.16-0.72), and more planned 1-day cirrhosis admissions (adj-IRR = 3.96, 95%CI 1.46-10.74). The total cost of cirrhosis admissions was lower for patients with 'good knowledge' (adj-IRR = 0.30, 95%CI 0.29-0.30). CONCLUSION Poor disease knowledge is associated with increased use and total cost of healthcare services. Targeted educational interventions to improve patient knowledge may be an effective strategy to promote a more cost-effective use of healthcare services.
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Affiliation(s)
- Patricia C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia. .,Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Christina M Bernardes
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | | | - Louisa G Gordon
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Penny L Wright
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Amy Johnson
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Truumees M, Kendra M, Tonzola D, Chiu S, Cerrone F, Zimmerman D, Mackwell C, Stevens C, Scannell K, Daley B, Markley D, Shah CV, Mansukhani R. The Impact of a Home Respiratory Therapist to Reduce 30-Day Readmission Rates for Exacerbation of COPD. Respir Care 2022; 67:631-637. [PMID: 34987079 PMCID: PMC9994190 DOI: 10.4187/respcare.08125] [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: 11/05/2022]
Abstract
BACKGROUND In 2015, the Centers for Medicare and Medicaid Services limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD disease management program delivered by a respiratory therapist (RT) in the patient's home may reduce readmission rates for COPD exacerbation. METHODS We performed a pre/post interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD disease management program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD disease management program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017-September 2019, and this served as the post-intervention group. The primary end point was readmission rates at 30 d. Secondary end points included 60-d and 90-d readmission rates. RESULTS A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% (n = 147) of subjects in the pre-intervention group was readmitted within 30 d of discharge compared to 12.2% (n = 53) in the post-intervention group (P < .001). A reduction in 60-d (33.9% vs 12.0%, P < .001) and 90-d all-cause readmissions (43.5% vs 13.1%, P < .001) was also seen. Participation in the COPD Disease Management Program was significantly associated with decreased 30-, 60-, and 90-d readmission rates adjusting for age, gender, race, ethnicity, and smoking status (odds ratio 0.48 [95% CI 0.33-0.70]; odds ratio 0.26 [95% CI 0.18-0.38]; odds ratio 0.20 [95% CI 0.14-0.27];P < .001, for all 3 readmission rates). CONCLUSIONS The COPD Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status.
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Affiliation(s)
- Monica Truumees
- Atlantic Health System/At Home Medical, Morris Plains, New Jersey
| | | | | | - Stephanie Chiu
- Atlantic Health Center of Research, Morristown, New Jersey
| | - Federico Cerrone
- Atlantic Medical Group/Pulmonary and Allergy Associates, Summit, New Jersey
| | | | | | | | | | | | - Daniel Markley
- Atlantic Medical Group/Pulmonary and Allergy Associates, Cedar Knolls, New Jersey
| | - Chirag V Shah
- Atlantic Medical Group/Pulmonary and Allergy Associates, Cedar Knolls, New Jersey
| | - Rupal Mansukhani
- Morristown Medical Center, Morristown, New Jersey; and Rutgers University, Piscataway, New Jersey.
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Lindenauer PK, Williams MV. Improving Outcomes after a Chronic Obstructive Pulmonary Disease Hospitalization: Lessons in Population Health from the U.S. Department of Veterans Affairs. Am J Respir Crit Care Med 2022; 205:1257-1258. [PMID: 35438614 PMCID: PMC9873122 DOI: 10.1164/rccm.202203-0613ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Peter K. Lindenauer
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School – BaystateSpringfield, Massachusetts
| | - Mark V. Williams
- Department of MedicineWashington University School of MedicineSt. Louis, Missouri
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Wu YK, Su WL, Yang MC, Chen SY, Wu CW, Lan CC. Associations Between Physical Activity, Smoking Status, and Airflow Obstruction and Self-Reported COPD: A Population-Based Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1195-1204. [PMID: 35620350 PMCID: PMC9128642 DOI: 10.2147/copd.s337683] [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: 09/04/2021] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with an increased mortality rate in recent years, mainly caused by exposure to tobacco smoke. Regular physical activity is thought to diminish the risk of COPD exacerbation, while very few studies investigate the interaction between smoking and physical activity on COPD development. This study aims to investigate the association between smoking status, physical activity and prevalent COPD. Methods This study analyzed data of adults 20 to 79 years old from the National Health and Nutrition Examination Survey (NHANES) 2007–2012. Results A total of 6404 participants aged 20–79 were included and divided into four groups by their physical activity levels and smoking status. Amongst, 2819 (43.7%) were physically active non-smokers, 957 (14.8%) were physically inactive non-smokers, 1952 (30.3%) were physically active smokers, and 717 (11.1%) were physically inactive smokers. Prevalence of airflow obstruction were 5.7%, 7.1%, 17.7% and 18.6%, respectively. After adjustment, physically active smokers (aOR=2.71, 95% CI=1.94–3.80) and physically inactive smokers (aOR=2.70, 95% CI=1.78–4.09) but not physically active non-smokers were more likely to have airflow obstruction than physically active non-smokers. These associations were similar among most subgroups by age, sex, or BMI. Among smokers, being physically inactive was not significantly associated with a greater chance for prevalent airflow obstruction than being physically active. Conclusion Smokers, regardless of their physical activity level, are more likely to have airflow obstruction as compared with physically active non-smokers. Within smokers, being physically inactive poses no excess chance to be airflow obstructed. The findings indicate that physical activity level seem not altering the relationship between smoking and airflow obstruction.
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Affiliation(s)
- Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Wen-Lin Su
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Sin-Yi Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chih-Wei Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
- Correspondence: Chou-Chin Lan, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Road, Xindian Dist., New Taipei City, Taiwan, Tel +886-2-66289779 ext 5709, Fax +886-2-66289009, Email
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Alqahtani KA, Gerlis C, Nolan CM, Gardiner N, Szczepura A, Man W, Singh SJ, Houchen-Wolloff L. SPACE FOR COPD delivered as a maintenance programme on pulmonary rehabilitation discharge: protocol of a randomised controlled trial evaluating the long-term effects on exercise tolerance and mental well-being. BMJ Open 2022; 12:e055513. [PMID: 35470190 PMCID: PMC9039383 DOI: 10.1136/bmjopen-2021-055513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The benefits achieved during pulmonary rehabilitation (PR) are known to be sustained for 6-12 months after the initial programme. Several maintenance trials have been conducted but were heterogeneous in terms of duration, frequency and labour cost. There is no consensus on one best strategy. SPACE FOR COPD (Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease) is a home-based self-management programme, which has been shown previously to be effective in primary and secondary care settings and is to be tested here as a maintenance programme. The aim is to evaluate the efficacy of the SPACE FOR COPD programme (manual and group sessions), on exercise tolerance and mental well-being, compared with usual care following PR in patients with COPD. METHODS AND ANALYSIS A prospective, multicentre, single-blinded randomised controlled trial requiring 116 participants with a clinical diagnosis of COPD who have finished PR within 4 weeks will be randomised 1:1 to either a usual care group or a SPACE FOR COPD programme group. The intervention comprises a home-based manual and 4, 2-hour group sessions adopting motivational interviewing techniques over 12 months. The primary outcome is endurance capacity measured by the Endurance Shuttle Walking Test at 12 months. Secondary outcomes are: maximal exercise capacity, health-related quality of life, mood, patient activation, physical activity, lung function and healthcare costs. The measures will be taken at baseline, 6 and 12 months. Patient interviews and staff focus groups will be conducted to explore barriers, facilitators and views about the intervention at the end of the study. A framework analysis will be used for the interpretation of qualitative data. ETHICS AND DISSEMINATION The trial was granted ethical approval from Health Research Authority and Health and Care Research Wales (HCRW19/EM/0267 on 10 October 2019). Results will be made available to all stakeholders through a dissemination event, conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN30110012.
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Affiliation(s)
- Khaled A Alqahtani
- Respiratory Therapy Department, Jazan University, Jazan, Saudi Arabia
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charlotte Gerlis
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Claire M Nolan
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nikki Gardiner
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Ala Szczepura
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - William Man
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Sally J Singh
- Respiratory Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
| | - Linzy Houchen-Wolloff
- Respiratory Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre- Respiratory, Glenfield Hospital Respiratory Medicine Department, Leicester, UK
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Caggianelli G, Iovino P, Rebora P, Occhino G, Zeffiro V, Locatelli G, Ausili D, Alvaro R, Riegel B, Vellone E. A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial. J Pain Symptom Manage 2022; 63:221-229.e1. [PMID: 34571194 DOI: 10.1016/j.jpainsymman.2021.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022]
Abstract
CONTEXT Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory. OBJECTIVE To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients. METHODS We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment. RESULTS At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02). CONCLUSION MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.
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Affiliation(s)
- Gabriele Caggianelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia.
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery (P.R., G.O.), University of Milan-Bicocca, Monza, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Giulia Locatelli
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science (P.I., G.L.), Australian Catholic University, Melbourne, Australia
| | - Davide Ausili
- Department of Medicine and Surgery (D.A.), University of Milan-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- School of Nursing (B.R.), University of Pennsylvania, Philadelphia, PA, USA; Mary McKillop Institute of Health Research (B.R.), Australian Catholic University, Melbourne, Australia
| | - Ercole Vellone
- Department of Biomedicine and Prevention (G.C., P.I., V.Z., G.L., R.A., E.V.), University of Rome Tor Vergata, Rome, Italy
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Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, Effing TW. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 1:CD002990. [PMID: 35001366 PMCID: PMC8743569 DOI: 10.1002/14651858.cd002990.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marlies Zwerink
- Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Comorbid conditions related to readmissions of Chinese older patients. Chin Med J (Engl) 2022; 135:741-743. [PMID: 34985022 PMCID: PMC9276289 DOI: 10.1097/cm9.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Indexed: 02/05/2023] Open
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Motivational regulations and lifestyle in muscle-wasted COPD patients undergoing pulmonary rehabilitation. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rausch Osthoff AK, Beyer S, Gisi D, Rezek S, Schwank A, Meichtry A, Sievi NA, Hess T, Wirz M. Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT. BMC Pulm Med 2021; 21:317. [PMID: 34641819 PMCID: PMC8506471 DOI: 10.1186/s12890-021-01685-2] [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: 03/08/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. Methods A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. Results Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. Conclusions In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
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Affiliation(s)
- Anne-Kathrin Rausch Osthoff
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland.
| | - Swantje Beyer
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - David Gisi
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Spencer Rezek
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Ariane Schwank
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - André Meichtry
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Hess
- Pneumology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
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Hudd TR. Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2021; 77:1625-1630. [PMID: 32699897 PMCID: PMC7499078 DOI: 10.1093/ajhp/zxaa216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Timothy R Hudd
- Department of Pharmacy Practice, MCPHS University, Boston, MA
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Federman AD, Barry M, Moas E, Davenport C, McGeough C, Tejeda M, Rivera L, Gutierrez S, Mejias H, Belton D, Mathew C, Lindenauer PK, McDermott D, O'Conor R, Wolf MS, Wisnivesky JP. Protocol for a feasibility randomized trial of self-management support for people with chronic obstructive pulmonary disease using lay health coaches. Contemp Clin Trials 2021; 110:106570. [PMID: 34560265 DOI: 10.1016/j.cct.2021.106570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
Challenges with self-management are a major contributor to poor outcomes among adults with chronic obstructive pulmonary disease (COPD). The causes of poor self-management in COPD are manifold, and they arise from physical, cognitive, socioeconomic, environmental and societal sources. To address this complexity, we developed the Supporting self-Management Behaviors in Adults with COPD (SaMBA-COPD) model, which uses lay health coaches to identify a patient's barriers to effective COPD self-management and provide tailored support to help them overcome those barriers, reduce their symptoms and need for urgent care and improve their quality of life. The 6-month intervention includes referral of patients to a pharmacist for prescription of antibiotic and oral steroid "rescue packs" and support for a structured home exercise routine. All interactions of coaches and patients will take place by telephone or video call. We will test the feasibility and preliminary efficacy of SaMBA-COPD in a trial of 58 patients randomized 1:1 to the intervention or a COPD education control. Outcomes will be assessed at 6 and 9 months. Data from the trial will be used to inform the design of a fully powered, multi-site randomized trial of the intervention.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Michele Barry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Esther Moas
- Mount Sinai Health System, New York, NY, United States of America
| | - Claire Davenport
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | - Leny Rivera
- City Health Works, New York, NY, United States of America
| | | | - Hilda Mejias
- City Health Works, New York, NY, United States of America
| | - Destini Belton
- City Health Works, New York, NY, United States of America
| | - Cathleen Mathew
- Mount Sinai Hospital, New York, NY, United States of America
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Sciences, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
| | | | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Poot CC, Meijer E, Kruis AL, Smidt N, Chavannes NH, Honkoop PJ. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2021; 9:CD009437. [PMID: 34495549 PMCID: PMC8425271 DOI: 10.1002/14651858.cd009437.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) show considerable variation in symptoms, limitations, and well-being; this often complicates medical care. A multi-disciplinary and multi-component programme that addresses different elements of care could improve quality of life (QoL) and exercise tolerance, while reducing the number of exacerbations. OBJECTIVES To compare the effectiveness of integrated disease management (IDM) programmes versus usual care for people with chronic obstructive pulmonary disease (COPD) in terms of health-related quality of life (QoL), exercise tolerance, and exacerbation-related outcomes. SEARCH METHODS We searched the Cochrane Airways Group Register of Trials, CENTRAL, MEDLINE, Embase, and CINAHL for potentially eligible studies. Searches were current as of September 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared IDM programmes for COPD versus usual care were included. Interventions consisted of multi-disciplinary (two or more healthcare providers) and multi-treatment (two or more components) IDM programmes of at least three months' duration. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. If required, we contacted study authors to request additional data. We performed meta-analyses using random-effects modelling. We carried out sensitivity analyses for the quality of included studies and performed subgroup analyses based on setting, study design, dominant intervention components, and region. MAIN RESULTS Along with 26 studies included in the 2013 Cochrane Review, we added 26 studies for this update, resulting in 52 studies involving 21,086 participants for inclusion in the meta-analysis. Follow-up periods ranged between 3 and 48 months and were classified as short-term (up to 6 months), medium-term (6 to 15 months), and long-term (longer than 15 months) follow-up. Studies were conducted in 19 different countries. The mean age of included participants was 67 years, and 66% were male. Participants were treated in all types of healthcare settings, including primary (n =15), secondary (n = 22), and tertiary care (n = 5), and combined primary and secondary care (n = 10). Overall, the level of certainty of evidence was moderate to high. We found that IDM probably improves health-related QoL as measured by St. George's Respiratory Questionnaire (SGRQ) total score at medium-term follow-up (mean difference (MD) -3.89, 95% confidence interval (CI) -6.16 to -1.63; 18 RCTs, 4321 participants; moderate-certainty evidence). A comparable effect was observed at short-term follow-up (MD -3.78, 95% CI -6.29 to -1.28; 16 RCTs, 1788 participants). However, the common effect did not exceed the minimum clinically important difference (MCID) of 4 points. There was no significant difference between IDM and control for long-term follow-up and for generic QoL. IDM probably also leads to a large improvement in maximum and functional exercise capacity, as measured by six-minute walking distance (6MWD), at medium-term follow-up (MD 44.69, 95% CI 24.01 to 65.37; 13 studies, 2071 participants; moderate-certainty evidence). The effect exceeded the MCID of 35 metres and was even greater at short-term (MD 52.26, 95% CI 32.39 to 72.74; 17 RCTs, 1390 participants) and long-term (MD 48.83, 95% CI 16.37 to 80.49; 6 RCTs, 7288 participants) follow-up. The number of participants with respiratory-related admissions was reduced from 324 per 1000 participants in the control group to 235 per 1000 participants in the IDM group (odds ratio (OR) 0.64, 95% CI 0.50 to 0.81; 15 RCTs, median follow-up 12 months, 4207 participants; high-certainty evidence). Likewise, IDM probably results in a reduction in emergency department (ED) visits (OR 0.69, 95%CI 0.50 to 0.93; 9 RCTs, median follow-up 12 months, 8791 participants; moderate-certainty evidence), a slight reduction in all-cause hospital admissions (OR 0.75, 95%CI 0.57 to 0.98; 10 RCTs, median follow-up 12 months, 9030 participants; moderate-certainty evidence), and fewer hospital days per person admitted (MD -2.27, 95% CI -3.98 to -0.56; 14 RCTs, median follow-up 12 months, 3563 participants; moderate-certainty evidence). Statistically significant improvement was noted on the Medical Research Council (MRC) Dyspnoea Scale at short- and medium-term follow-up but not at long-term follow-up. No differences between groups were reported for mortality, courses of antibiotics/prednisolone, dyspnoea, and depression and anxiety scores. Subgroup analysis of dominant intervention components and regions of study suggested context- and intervention-specific effects. However, some subgroup analyses were marked by considerable heterogeneity or included few studies. These results should therefore be interpreted with caution. AUTHORS' CONCLUSIONS This review shows that IDM probably results in improvement in disease-specific QoL, exercise capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of IDM components and which intervention duration are most effective for IDM programmes, and should consider contextual determinants of implementation and treatment effect, including process-related outcomes, long-term follow-up, and cost-effectiveness analyses.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
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Tsao S, Willard-Grace R, Wolf J, Chirinos C, De Vore D, Huang B, Su G, Thom DH. Implementation and Impact of the Pulmonary Specialist Health Coach Consultation Model to Improve Care for Patients with COPD. Jt Comm J Qual Patient Saf 2021; 47:739-747. [PMID: 34489189 DOI: 10.1016/j.jcjq.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health coaching has emerged as an important tool for improving patient-centered care in primary care practice but has not specifically been evaluated for patients whose care is shared by a primary care provider (PCP) and specialist. METHODS As part of a nine-month randomized controlled trial comparing health coaching to usual care for patients with chronic obstructive pulmonary disease (COPD), the authors developed the Pulmonary Specialist Health Coach Consultation (PuSHCon). In this novel model, health coaches facilitated pulmonary specialist consultations for patients with COPD without the need for an in-person visit. Observational data from the randomized controlled trial were analyzed to study the implementation, adoption, and impact of the PuSHCon model for 70 of 92 patients randomized to the health coaching arm and for 17 of 100 patients in the control arm (who received PuSHCon after the end of the study). Quality of care was measured using the Patient Assessment of Chronic Illness Care (PACIC). RESULTS Of 87 patients who participated in PuSHCon, 74 (85.1%) received one or more specialist recommendations, of which 86.8% were implemented. Only 12 patients (13.8%) subsequently required an in-person visit with the PuSHCon specialist. The proportion of PuSHCon participants receiving guideline-concordant care increased from 64.7% to 94.1% (p < 0.001). The mean PACIC item score increased from 3.48 to 3.74 (p = 0.03). CONCLUSION The PuSHCon model facilitated consultations that resulted in changes in care, which were implemented for a majority of patients. Guideline-concordant care and patient-reported quality of care increased over nine months. This model could potentially be expanded to help patients with other chronic conditions when PCPs and specialists share patient care.
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Scheermesser M, Reicherzer L, Beyer S, Gisi D, Rezek S, Hess T, Wirz M, Rausch Osthoff AK. The Influence of Pulmonary Rehabilitation and Counselling on Perceptions of Physical Activity in Individuals with COPD - A Qualitative Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2337-2350. [PMID: 34421298 PMCID: PMC8372306 DOI: 10.2147/copd.s315130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/30/2021] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to explore to what extent a combined counselling and pulmonary rehabilitation program (PR) influences the perception of physical activity (PA) and motivation for behavioral change in PA in individuals with COPD. The results of previous quantitative trial that investigated the effect of this combined treatment on daily PA were inconclusive. It is conjectured that a more targeted tailoring of the counselling and PR intervention could improve its effectiveness. Patients and Methods Eighteen individuals with COPD (median age 69, 8 females) who had participated in the PneumoReha program were interviewed twice (following PR and at three-month follow-up). These interviews were transcribed and analyzed thematically. Based on the codes thus identified, three categories 'perception of PA intensity', 'quality of motivation to perform PA', and 'strategies to cope with barriers' were used to differentiate 'types' of participants. Results Four different types of COPD individuals were distinguished. Study findings indicate that those individuals who participated in the PR program combined with embedded counselling tended to be more active and intrinsically motivated. Conclusion A typology of four types of people with COPD was developed, characterized by their perception of activity, individual motivation and strategies for managing barriers. The patients' physical activity level might be influenced by their concept of physical activity and the quality of motivation. Recognizing patients' different activity behaviors is important for improving the quality of outpatient PR programs and developing tailored (according to each type) counselling interventions embedded in outpatient PR programs. Clinical Trial Registration The study was registered on the website of https://www.clinicaltrials.gov/ with the identifier NCT02455206 (27/05/2015), as well as on the Swiss National Trails Portal SNCTP000001426 (05/21/2015).
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Affiliation(s)
- Mandy Scheermesser
- Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute for Physiotherapy, Winterthur, 8400, Switzerland
| | - Leah Reicherzer
- Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute for Physiotherapy, Winterthur, 8400, Switzerland
| | - Swantje Beyer
- Cantonal Hospital Winterthur (KSW), Pneumology, Winterthur, 8401, Switzerland
| | - David Gisi
- Cantonal Hospital Winterthur, Institute of Physiotherapy, Winterthur, 8401, Switzerland
| | - Spencer Rezek
- Cantonal Hospital Winterthur, Institute of Physiotherapy, Winterthur, 8401, Switzerland
| | - Thomas Hess
- Cantonal Hospital Winterthur (KSW), Pneumology, Winterthur, 8401, Switzerland
| | - Markus Wirz
- Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute for Physiotherapy, Winterthur, 8400, Switzerland
| | - Anne-Kathrin Rausch Osthoff
- Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute for Physiotherapy, Winterthur, 8400, Switzerland
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Sharpe I, Bowman M, Kim A, Srivastava S, Jalink M, Wijeratne DT. Strategies to Prevent Readmissions to Hospital for COPD: A Systematic Review. COPD 2021; 18:456-468. [PMID: 34378468 DOI: 10.1080/15412555.2021.1955338] [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
Patients with chronic obstructive pulmonary disease (COPD) experience high rates of hospital readmissions, placing substantial clinical and economic strain on the healthcare system. Therefore, it is essential to implement evidence-based strategies for preventing these readmissions. The primary objective of our systematic review was to identify and describe the domains of existing primary research on strategies aimed at reducing hospital readmissions among adult patients with COPD. We also aimed to identify existing gaps in the literature to facilitate future research efforts. A total of 843 studies were captured by the initial search and 96 were included in the final review (25 randomized controlled trials, 37 observational studies, and 34 non-randomized interventional studies). Of the included studies, 72% (n = 69) were considered low risk of bias. The majority of included studies (n = 76) evaluated patient-level readmission prevention strategies (medication and other treatments (n = 25), multi-modal (n = 19), follow-up (n = 16), telehealth (n = 8), education and coaching (n = 8)). Fewer assessed broader system- (n = 13) and policy-level (n = 7) strategies. We observed a trend toward reduced all-cause readmissions with the use of medication and other treatments, as well as a trend toward reduced COPD-related readmissions with the use of multi-modal and broader scale system-level interventions. Notably, much of this evidence supported shorter-term (30-day) readmission outcomes, while little evidence was available for longer-term outcomes. These findings should be interpreted with caution, as considerable between-study heterogeneity was also identified. Overall, this review identified several evidence-based interventions for reducing readmissions among patients with COPD that should be targeted for future research.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1955338 .
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Affiliation(s)
- Isobel Sharpe
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Meghan Bowman
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Andrew Kim
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Siddhartha Srivastava
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Matthew Jalink
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Don Thiwanka Wijeratne
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
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Jordan MA. The Role of the Health Coach in a Global Pandemic. Glob Adv Health Med 2021; 10:21649561211039456. [PMID: 34395059 PMCID: PMC8361512 DOI: 10.1177/21649561211039456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While medical teams were perplexed about the novel SARS-CoV-2 infection, transmission and impairment of organ systems and immune function, viral infections spread worldwide. Complex intersectional issues of co-morbidities coupled with marginalized, diverse ethnic/racial populations emerged as significant risks to contracting severe COVID-19. OBJECTIVE Since a healthy lifestyle is fundamental for lowering risk to chronic diseases, public health initiatives to manage this and future pandemics should include strategies that assist individuals to improve health status through targeted behavior changes. This conceptual paper builds a case for certified professional health coaches as primary actors in future preventive strategies, with expanded skills in addressing social determinants of health and "next generational" cultural competencies. METHODS This concept paper primarily synthesizes fast-tracked research in 2020 regarding the demographic impact of COVID-19, specifically those groups suffering the highest morbidity and mortality rates. Exploring these intersectional issues through a conceptual lens provides strategies for certified health coaches to contribute their expertise in behavioral change within the larger contextual settings of racial/ethnic disparities and social inequities. RESULTS As the co-morbidities and other chronic conditions related to COVID-19 among individuals and families in low-income communities are worsened by dual forces (lifestyle/behavioral choices and ingrained structural inequities), adding the support of certified health coaches to build trust, provide more convenient access to address vaccine hesitancy, and dispell falsehoods, is an effective means for advancing health and wellbeing. Group coaching and one-on-one coaching can work in tandem with public health initiatives for reducing chronic disease burden and addressing social determinants of health (SDoH). Skills are identified in coaching SDoH with expanded cultural competencies for health coaches. CONCLUSION Certified professional health coaches can make a positive impact on general risk reduction of chronic diseases within ethnic/racial minorities, thereby supporting population health in facing future contagions with greater health resilience.
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Affiliation(s)
- Meg A Jordan
- School of Professional Psychology and Health, California Institute of Integral Studies, San Francisco, California
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Sarabia-Cobo C, Pérez V, de Lorena P, Sáenz-Jalón M, Alconero-Camarero AR. Effectiveness of a telephone intervention based on motivational health coaching for improving the mental health of caregivers of people with dementia: A randomised controlled trial. Int J Older People Nurs 2021; 16:e12398. [PMID: 34337869 DOI: 10.1111/opn.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/17/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Caring for a family member with dementia is considered one of the activities with the greatest negative impact on a person's mental health. Developing long-lasting and effective strategies is a challenge for caregivers. This study sought to evaluate the impact of an intervention based on a programme of motivational coaching delivered by telephone in a group of caregivers of patients with dementia compared to a control group. METHODS A randomised controlled trial with a control group and an intervention group. (CONSORT guidelines were used). Telephone calls were made during six weeks, involving a process of coaching and motivational interviews. The following variables were measured in caregivers: self-efficacy of caring, depression, perceived stress, frequency of problematic behaviours and dysfunctional thoughts. Assessments were conducted at three time points: baseline, post-intervention and three months' post-intervention. RESULTS In total, 106 caregivers participated (53 subjects in the control group and 53 in the intervention group). Statistically significant differences (ANCOVA) were found between both groups for the self-efficacy and stress variables, with improved results in the intervention group (p < .01). Furthermore, statistically significant differences were found in the intervention group between the baseline and post-intervention assessments, with improvements in self-efficacy, decreased stress and decreased dysfunctional thoughts (p < .05). The results were maintained over time for both groups. CONCLUSIONS An intervention based on telephone calls using a health coaching approach with motivational interviewing appears to be effective for the improvement of self-efficacy and mental health of caregivers of people with moderate dementia. Furthermore, these effects appear to be maintained over time.
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Affiliation(s)
- Carmen Sarabia-Cobo
- Nursing Research Group IDIVAL, Faculty of Nursing, University of Cantabria, Santander, Spain
| | | | | | - María Sáenz-Jalón
- Hospital 12 de Octubre, Nursing Research Group IDIVAL, Madrid, Spain
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Bourbeau J, Echevarria C. Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease. Chron Respir Dis 2021; 17:1479973119895457. [PMID: 31970998 PMCID: PMC6978821 DOI: 10.1177/1479973119895457] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with
significant morbidity and mortality, and treatments require a multidisciplinary
approach to address patient needs. This review considers different models of
care across the continuum of exacerbations (1) chronic care and self-management
interventions with the action plan, (2) domiciliary care for severe exacerbation
and the impact on readmission prevention and (3) the discharge care bundle for
management beyond the acute exacerbation episode. Self-management strategies
include written action plans and coaching with patient and family support.
Self-management interventions facilitate the delivery of good care, can reduce
exacerbations associated with admission, be cost-effective and improve quality
of life. Hospitalization as a complication of exacerbation is not always
unavoidable. Domiciliary care has been proposed as a solution to replace part,
and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital
bed days, readmission rates and costs; low-risk patients can be identified using
risk stratification tools. A COPD discharge bundle is another potentially
important approach that can be considered to improve the management of COPD
exacerbations complicated by hospital admission; it comprised treatments that
have demonstrated efficacy, such as smoking cessation, personalized
pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD
bundles may also improve the transition of care from the hospital to the
community following exacerbation and may reduce readmission rates. Future models
of care should be personalized – providing patient education aiming at behaviour
changes, identifying and treating co-morbidities, and including outcomes that
measure quality of care rather than focusing only on readmission quantity within
30 days.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Carlos Echevarria
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Benzo RP, Ridgeway J, Hoult JP, Novotny P, Thomas BE, Lam NM, V Benzo M, Kramer K, Seifert S. Feasibility of a Health Coaching and Home-Based Rehabilitation Intervention With Remote Monitoring for COPD. Respir Care 2021; 66:960-971. [PMID: 33906954 PMCID: PMC10027177 DOI: 10.4187/respcare.08580] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary rehabilitation is an effective treatment for patients with COPD, but patient uptake and adherence to the current offering of center-based pulmonary rehabilitation is modest due to transportation, access, poverty, and frailty, and even more so in the context of the COVID pandemic. Home-based options have been proposed and were found noninferior to center-based rehabilitation; however, there is a lack of home-based programs, and more understanding is needed. We aimed to test the feasibility, uptake, and adherence to a home-based program for COPD rehabilitation with health coaching. METHODS We conducted a randomized trial with a wait-list controlled design to evaluate the effects of a home-based program with health coaching on breathlessness in subjects with moderate to severe COPD unable to attend the regular pulmonary rehabilitation program. The 8-week intervention consisted of video-guided exercises to be done 6 times a week and captured with a computer tablet. Health coaching was done weekly over the telephone to review subject activity and symptoms and to provide an opportunity for the subject to define their weekly goals. The primary outcomes were uptake, adherence, and Chronic Respiratory Questionnaire (CRQ) Dyspnea Domain. Secondary outcomes were self-management abilities and CRQ Emotions-Mastery-Fatigue. RESULTS 154 subjects with moderate to severe COPD were randomized. Subject adherence was 86% to the proposed 6-times a week exercise routine. There (P = .062) was no significant difference in breathlessness (CRQ dyspnea). There was a significant improvement in self-management abilities (P < .001). The results of the qualitative interviews showed high levels of acceptability of the program. CONCLUSIONS The tested home-based rehabilitation program with health coaching was feasible, highly acceptable, showed a high degree of adherence, and improved self-management abilities. This study offers seminal information for home-based rehabilitation programs to design alternative options of rehabilitation to individuals with COPD that cannot attend to the well-established center-based pulmonary rehabilitation. (ClinicalTrials.gov registration NCT02557178.).
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Affiliation(s)
- Roberto P Benzo
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota.
| | | | - Johanna P Hoult
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Paul Novotny
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Benjamin E Thomas
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Nyanjok M Lam
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Maria V Benzo
- Department of Pulmonary and Critical Care Medicine, Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Kevin Kramer
- Minnesota Health Solutions, Minneapolis, Minnesota
| | - Sara Seifert
- Minnesota Health Solutions, Minneapolis, Minnesota
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Roberts NJ, Kidd L, Kirkwood K, Cross J, Partridge MR. How is the education component of pulmonary rehabilitation delivered in practice--Is it patient-centred? CLINICAL RESPIRATORY JOURNAL 2021; 15:835-842. [PMID: 33825323 DOI: 10.1111/crj.13371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pulmonary rehabilitation (PR) involves a significant component of education, but little has been published on what educational content is covered or how it is delivered. This survey study set out to investigate how PR education is delivered in practice. METHODS A survey was designed to investigate the current educational delivery and which topics respondents reported should be included in a PR programme. The survey was sent to 11 Scottish PR Action group regional leads. RESULTS Nine completed the questionnaire (81.8%). Education was reported to be predominately group-based and face-to-face (n = 9, 100%) consisting of between 6 and 12 sessions. Most educational topics lasted 15 min or less, some topic areas were not consistently covered. The educational content was variable and not personalised to individual needs. Three health areas undertook informal literacy assessment at baseline assessment and when tailoring COPD plans. Often attendance at educational sessions was not needed to 'complete' PR. CONCLUSIONS Content and delivery of educational topics were varied, and no consistent outcome measure to assess the effectiveness of education was used. PRACTICE IMPLICATIONS Education needs to be delivered in a patient-centred way tailoring for literacy skills using a range of different teaching approaches and aids.
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Affiliation(s)
- Nicola J Roberts
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Kidd
- Nursing & Health Care School, University of Glasgow, Glasgow, UK
| | - Kim Kirkwood
- Pulmonary Rehabilitation, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jane Cross
- School of Health Life Sciences, University of East Anglia, Norwich, UK
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