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He Y, Zhu H, Xu W, Wang T, Chen Y. Wound healing rates in COPD patients undergoing traditional pulmonary rehabilitation versus tailored Wound-Centric interventions. Int Wound J 2024; 21:e14863. [PMID: 38606653 PMCID: PMC11009941 DOI: 10.1111/iwj.14863] [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: 02/23/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
This comparative cross-sectional study, conducted at Shanghai Pulmonary Hospital, aimed to evaluate the efficacy of tailored wound-centric interventions (TWCI) versus traditional pulmonary rehabilitation (TPR) in enhancing wound healing in patients with chronic obstructive pulmonary disease (COPD). Enrolling 340 patients with confirmed COPD, the study randomly assigned participants to either the TWCI or TPR group for a 12-week programme. The primary outcome measured was the rate of wound healing, with secondary outcomes including changes in pulmonary function tests (PFTs) and quality of life (QoL) scores. The TWCI group received a customized programme integrating standard pulmonary rehabilitation with specific wound care strategies, such as enhanced oxygen therapy, nutritional supplementation, and infection control measures. In contrast, the TPR group underwent a conventional pulmonary rehabilitation programme without targeted wound care interventions. Wound healing rates, PFTs, and QoL scores were assessed at the end of the intervention and 3 months post-intervention. The TWCI group demonstrated a statistically significant improvement in wound healing rates compared with the TPR group. The TWCI group had a 15% higher rate of reduction in wound size, a 10% rise in complete healing rates, and a 20% drop in infection rates (p < 0.05). Specifically, TWCI group exhibited higher rates of wound size reduction, complete healing, and decreased infection rates. Additionally, long-term pulmonary function and overall quality of life improvements were more pronounced in the tailored group, underscoring the benefits of a personalized approach to managing COPD and wound care. The study concluded that integrating wound-specific care strategies with pulmonary rehabilitation significantly enhances health outcomes in COPD patients with wounds. These findings supported the adoption of customized, multidisciplinary care plans, suggesting that tailored interventions can offer a comprehensive solution to the complex needs of COPD patients, potentially redefining best practices in chronic disease management.
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Affiliation(s)
- Yan He
- Department of Respiratory and Critical Care MedicineShanghai Fourth People's Hospital Affiliated to Tongji UniversityShanghaiChina
| | - He Zhu
- Department of Thoracic Care UnitShanghai Pulmonary HospitalShanghaiChina
| | - Wenjie Xu
- Department of Respiratory and Critical Care MedicineShanghai Pulmonary HospitalShanghaiChina
| | - Tao Wang
- Department of Thoracic Care UnitShanghai Pulmonary HospitalShanghaiChina
| | - Ying Chen
- Nursing DepartmentShanghai Fourth People’s Hospital Affiliated to Tongji UniversityShanghaiChina
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Lin CH, Li YR, Wang BY, Lin SH, Huang KY, Chen CH, Kor CT. The impact of the duration of the integrated disease management program on COPD-related outcomes. Eur J Med Res 2023; 28:178. [PMID: 37221574 DOI: 10.1186/s40001-023-01136-0] [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] [Received: 02/23/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the impact of the duration of the integrated disease management (IDM) program on COPD-related outcomes in real-world setting. METHODS A retrospective cohort study among 3771 patients with COPD who had regularly completed 4 visits of IDM program within 1 year between April 1, 2017 and December 31, 2018. CAT score as the primary outcome used to investigate the association between IDM intervention duration and improvement in CAT score. Change in CAT score from baseline to each follow-up visit determined by using least-squares means (LSMeans) approach. The cut-off value of IDM duration for improving the CAT score was determined by the Youden index. Logistic regression was used to analyze the relationship between IDM intervention duration and MCID (the minimal clinically important difference) improvement in CAT score and the factor associated CAT improvement. Risks of COPD exacerbation events (COPD-related ED visit and COPD-related hospitalization) were estimated by using the cumulative incidence curve and Cox proportional hazards models. RESULT Among 3771 enrolled COPD patients, the majority of the study cohort were males (91.51%) and 42.7% of patients had CAT score of ≥ 10 at baseline. The mean of age was 71.47 years and the mean CAT at baseline were 10.49. The mean change from baseline in CAT score was - 0.87, - 1.19, - 1.23 and - 1.40 at 3-, 6-, 9- and 12 month follow-up (p < 0.0001 for all visits), respectively. Statistically significantly lower likelihood of achieving MCID improvement in CAT were observed at 3- and 6 month compared to 9 month (at 3 month: OR: 0.720, 95% CI 0.655-0.791; at 6 month: OR: 0.905, 95% CI 0.825-0.922). And only a modest increase likelihood of achieving MCID improvement in CAT at 12 month (OR: 1.097, 95% CI 1.001-1.201) compared with 9-month follow-up. In logistic regression on the entire cohort, CAT MCID improvement was most associated with baseline CAT scores ≥ 10, followed by frequent exacerbation in previous year (> 2 episodes/year), wheezing, and GOLD B or D at baseline. In baseline CAT ≥ 10 group, patients were more likely to achieve CAT MCID improvement and had greater decreases from baseline in CAT score observed at 3-, 6-, 9-, and 12 month compared with baseline CAT score < 10 group (all p < 0.0001). Moreover, in CAT ≥ 10 groups, patients who achieved CAT MCID improvement had lower risk of subsequent COPD exacerbation events (COPD-related ED visit: aHR: 1.196, 95% CI 0.985-1.453, p = 0.0713; COPD-related hospitalization: aHR: 1.529, 95% CI 1.215-1.924, p = 0.0003) when compared to those without. CONCLUSION This is the first real-world study indicating the association between COPD IDM intervention duration and COPD-related outcomes. From 3 to 12 month follow-up results showed that continued improvement over time in COPD-specific health status, particularly in patients with baseline CAT score of ≥ 10. Furthermore, a reduction of the risk of subsequent COPD exacerbations were observed in patients with CAT MCID improvement.
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Affiliation(s)
- Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 50006, Taiwan.
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
- National Chung Hsing University, Taichung, Taiwan.
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan.
| | - Yi-Rong Li
- Thoracic Medicine Research Center, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Bing-Yen Wang
- Department of Surgery, Division of Thoracic Surgery, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 50006, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Kuo-Yang Huang
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 50006, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Cheng-Hsiung Chen
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 50006, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, 500, Taiwan
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, 500, Taiwan
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Pierucci P, Santomasi C, Ambrosino N, Portacci A, Diaferia F, Hansen K, Odemyr M, Jones S, Carpagnano GE. Patient's treatment burden related to care coordination in the field of respiratory diseases. Breathe (Sheff) 2021; 17:210006. [PMID: 34295410 PMCID: PMC8291948 DOI: 10.1183/20734735.0006-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Carla Santomasi
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Andrea Portacci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Fabrizio Diaferia
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Kjeld Hansen
- European Lung Foundation Chair, Sheffield, UK
- Dept of Technology, Kristiana University College Oslo, Norway
| | - Mikaela Odemyr
- European Lung Foundation Council Member and Patient Advisory Committee Chair, Sheffield, UK
| | - Steve Jones
- European Lung Foundation Council Member, Sheffield, UK
- Action for Pulmonary Fibrosis, Peterborough, UK
- EU IPFF, Brussels, Belgium
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
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Longman J, Johnston J, Ewald D, Gilliland A, Burke M, Mutonga T, Passey M. What could prevent chronic condition admissions assessed as preventable in rural and metropolitan contexts? An analysis of clinicians' perspectives from the DaPPHne study. PLoS One 2021; 16:e0244313. [PMID: 33411717 PMCID: PMC7790391 DOI: 10.1371/journal.pone.0244313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Reducing potentially preventable hospitalisations (PPH) is a priority for health services. This paper describes the factors that clinicians perceived contributed to preventable admissions for angina, diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), and what they considered might have been done in the three months leading up to an admission to prevent it. METHODS The study was conducted in a rural and a metropolitan health district in NSW, Australia. Expert Panels reviewed detailed case reports to assess preventability. For those admissions identified as preventable, comments from clinicians indicating what they perceived could have made a difference and/or been done differently to prevent each of the preventable admissions were analysed qualitatively. RESULTS 148 (46%) of 323 admissions were assessed as preventable. Across the two districts, the most commonly identified groups of contributing factors to preventable admissions were: 'Systems issues: Community based services missing or inadequate or not referred to'; 'Patient issues: Problems with adherence/self-management'; and 'Clinician issues: GP care inadequate'. In some instances, important differences drove these groups of factors. For example, in the rural district 'Systems issues: Community based services missing or inadequate or not referred to' was largely driven by social and welfare support services missing/inadequate/not referred to, whereas in the metropolitan district it was largely driven by community nursing, allied health, care coordination or integrated care services missing/inadequate/not referred to. Analyses revealed the complexity of system, clinician and patient factors contributing to each admission. Admissions for COPD (rural) and CHF (metropolitan) admissions showed greatest complexity. DISCUSSION AND CONCLUSION These findings suggest preventability of individual admissions is complex and context specific. There is no single, simple solution likely to reduce PPH. Rather, an approach addressing multiple factors is required. This need for comprehensiveness may explain why many programs seeking to reduce PPH have been unsuccessful.
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Affiliation(s)
- Jo Longman
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- * E-mail:
| | - Jennifer Johnston
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Dan Ewald
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- North Coast Primary Health Network, Ballina, NSW, Australia
| | | | - Michael Burke
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Tabeth Mutonga
- Mt Druitt Community Health Centre, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Megan Passey
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
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Carone M, Pennisi A, D'Amato M, Donati AF, Ricci A, Scognamillo C, Chun L, Aliani M, Ronsivalle V, Pelaia G. Physical Functioning in Patients with Chronic Obstructive Pulmonary Disease Treated with Tiotropium/Olodaterol Respimat in Routine Clinical Practice in Italy. Pulm Ther 2020; 6:261-274. [PMID: 32557394 PMCID: PMC7672142 DOI: 10.1007/s41030-020-00122-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Clinical studies have shown significant improvements in exercise capacity in patients with chronic obstructive pulmonary disease (COPD) who are treated with a tiotropium/olodaterol fixed-dose combination (FDC). However, the effects of this treatment, which is administered in a single device, on physical functioning in a real-life setting of patients with COPD had not been fully determined. Methods An open-label, observational study was conducted in 309 patients with COPD from 29 sites across Italy who received tiotropium/olodaterol FDC for 6 weeks. Physical functioning was evaluated using the Physical Functioning Questionnaire (PF-10). The primary endpoint was the proportion of patients with therapeutic success, defined as a ten-point increase in the PF-10 score from the baseline visit. Secondary endpoints were absolute changes in PF-10 score from baseline visit, the patient’s general condition assessed by the Physician’s Global Evaluation (PGE) score, and patient satisfaction with treatment, inhaling and handling of the device. Results According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) multimodality assessment, most patients were allocated to groups B (44.4%) and D (24.5%). Comorbidities were present in 73.9% of the patients. The primary endpoint was reached in more than half of the patients (52.5%), especially in groups B and D of GOLD. Patients’ satisfaction with treatment, inhaling and handling of device was high, with a range of more than 86% to more than 89%, and very high in both groups B and D. The rates of drug-related adverse events were very low. Conclusions This real-life study showed that the tiotropium/olodaterol FDC treatment delivered via the Respimat device improves physical functioning and general patients’ condition and is associated with a high degree of satisfaction and very low rates of drug-related adverse events, regardless of the group they belong to and their comorbidities. Clinical Trial ID NCT03003494. Electronic supplementary material The online version of this article (10.1007/s41030-020-00122-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mauro Carone
- Division of Pneumology, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4, 27100, Pavia, Italy.
| | - Alfio Pennisi
- Department of Pneumology, Casa Di Cura Mons. Calaciuria, Catania, Italy
| | | | | | - Alberto Ricci
- Department of Pneumology, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | - Li Chun
- Boehringer-Ingelheim, Ridgefield, CT, USA
| | - Maria Aliani
- Division of Pneumology, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4, 27100, Pavia, Italy
| | | | - Girolamo Pelaia
- Department of Scienze Mediche E Chirurgiche, Università "Magna Grecia", Catanzaro, Italy
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Schuurman HJ. Invited Commentary on: Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Review article [Int J Surg 2019]. Int J Surg 2020; 74:107-108. [DOI: 10.1016/j.ijsu.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
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