COPD a social disease: inappropriateness and pharmaco-economics. The role of the specialist: present and future

Promoting Health Literacy and Perceived Self-Efficacy in People with Chronic Obstructive Pulmonary Disease

Background

Chronic Obstructive Pulmonary Disease (COPD) is an irreversible condition and it is of great importance for the patients to practice self-care. Given the impact of inadequate health literacy on people's self-efficacy in a self-care program, the aim of this study was to improve health literacy and self-efficacy in people with COPD.

Materials and Methods

The present quasi-experimental study was conducted on 70 patients with COPD admitted to Shahrekord educational hospitals in 2019. Using random allocation software, the samples were randomly divided into intervention and control groups. Data collection tools included three questionnaires including demographic, health literacy, and perceived self-efficacy questionnaires. A training program, with three weekly sessions of theoretical and practical trainings, was conducted for the intervention group in classes in the hospital. The time of each session was 40 min. Data were collected three times i.e., before, immediately after, and three months after the trainings. Data were analyzed by means of SPSS 21 statistical software using descriptive and inferential statistics.

Results

Before the intervention, the mean scores of perceived self-efficacy and health literacy did not differ significantly between the two groups, but after the intervention, the scores of the members in the intervention group increased significantly (f = 62.15, p < 0.05).

Conclusions

The results of the study indicated an increase in the scores of perceived self-efficacy and health literacy in people with COPD. The use of targeted educational interventions can have a positive effect on the treatment and control of the disease.

Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation

BACKGROUND

To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8-30 days after discharge).

METHODS

Patients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions.

RESULTS

Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003-0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060-0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009-0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028-0.459]).

CONCLUSIONS

In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.