1
|
Qi W, Huang K, Chen Q, Jiao L, Yu F, Yu Y, Niu H, Li W, Fang F, Lei J, Chu X, Li Z, Geldsetzer P, Bärnighausen T, Chen S, Yang T, Wang C. Portable spirometer-based pulmonary function test willingness in China: A nationwide cross-sectional study from the "Happy Breathing Program". Chin Med J (Engl) 2024; 137:1695-1704. [PMID: 38955430 PMCID: PMC11268818 DOI: 10.1097/cm9.0000000000003121] [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: 10/14/2023] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs. METHODS We collected data from participants in the "Happy Breathing Program" in China. Participants who did not follow physicians' recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs. RESULTS A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility ( n = 3304, 43.1%) and a lack of trust in primary healthcare institutions ( n = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half ( n = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation "COPD" were more willing to undergo PFTs. CONCLUSIONS Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.
Collapse
Affiliation(s)
- Weiran Qi
- Department of Health Economics and Health Policy, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lirui Jiao
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Fengyun Yu
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg 69120, Germany
| | - Yiwen Yu
- Department of Health Economics and Health Policy, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fang Fang
- Administration Office of Medical Reform and Development, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jieping Lei
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xu Chu
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zilin Li
- Department of Statistics, School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin 130024, China
| | - Pascal Geldsetzer
- Chan Zuckerberg Biohub, Stanford University School of Medicine, San Francisco,CA 94158, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Till Bärnighausen
- Department of Health Economics and Health Policy, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg 69120, Germany
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA 02138, USA
| | - Simiao Chen
- Department of Health Economics and Health Policy, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg 69120, Germany
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chen Wang
- Department of Health Economics and Health Policy, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
2
|
Fernández-Sánchez MC, Ruiz-López FJ, Ros-Lucas JA, Andújar-Espinosa R, Del Coso J, García-Pastor T. Persons With Chronic Obstructive Pulmonary Disease and High Levels of Activation Improved Their Physical Activity Skills After an Educational Session. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:270-281. [PMID: 38527191 PMCID: PMC11216225 DOI: 10.15326/jcopdf.2023.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
Background Daily physical activity is part of the self-management of patients with chronic obstructive pulmonary disease (COPD), and didactic information sessions may be insufficient for the provision of these skills. Prior activation can determine sensitivity to these sessions. We evaluated whether the activation in patients with COPD, as measured by the Patient Activation Measure (PAM)-13 questionnaire, determined their responses to an educational group session on physical activity (PA), which were measured with actigraphy by the number of steps/day. Methods We conducted an uncontrolled clinical trial in an outpatient clinic with 75 patients with nonexacerbating COPD (forced expiratory volume in 1 second 30%-80%) who were selected consecutively. Patients were provided with an actigraph that they used for 15 days and completed the PAM-13 questionnaire. On the eighth day, they attended a group educational session where they were given PA information. We compared the changes in activity after the session by pooled PAM levels and the correlation between the change in the number of steps/day and the PAM-13 questionnaire. Results A total of 26 patients had activation levels of 1-2, while 49 patients had levels of 3-4. After the session, patients in Levels 1-2 decreased their number of steps (-596±42), while those in Levels 3-4 increased them (680±253, p<0.01). The level of activation was positively correlated with change in the number of steps/day (p<0.05). Conclusion COPD patients with greater activation showed greater improvements in daily PA after a group educational session.
Collapse
Affiliation(s)
| | | | - José A Ros-Lucas
- Pneumonology Service, Arrixaca University Hospital, Murcia, Spain
| | | | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Spain
| | | |
Collapse
|
3
|
Alqallaf A. The Impact of Integrated Patient Education on Short-Term Revisit Rates in Healthcare Settings: A Quality Improvement Project. Cureus 2024; 16:e56512. [PMID: 38646365 PMCID: PMC11026867 DOI: 10.7759/cureus.56512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Patient education plays a critical role in healthcare, influencing outcomes and resource utilization. However, effectively integrating patient education into clinical practice remains challenging due to time constraints and inconsistencies in information delivery. Enhancements in Electronic Health Records (EHR) offer potential solutions by facilitating customized, quality education delivery. This study investigates the impact of an EHR-enhanced patient education intervention on short-term revisit rates to healthcare facilities. METHODS A quasi-experimental, pre-test/post-test design without a control group was employed at the International Medical Center in Riffa, Bahrain. The intervention consisted of modifications to the EHR system to support patient education, along with staff training on effective education delivery. Patient revisit rates within seven days post-consultation were compared before and after the intervention using chi-square tests and logistic regression, adjusting for potential confounders. RESULTS A total of 1,239 patients participated in the study, which was divided into two groups: 754 patients in the pre-intervention group and 485 patients in the post-intervention group. A significant change was observed in the patient revisit rates: in the pre-intervention group, 53.32% of patients (402 out of 754) returned within seven days, compared to 41.44% of patients (201 out of 485) in the post-intervention group, with a p-value < 0.01. CONCLUSION Enhancements to EHR systems, combined with comprehensive staff education on patient education, can lead to significant reductions in short-term patient revisits. This underscores the importance of integrating technological and educational interventions in healthcare settings to improve patient outcomes and efficiency.
Collapse
|
4
|
Jiang T, Liu C, Jiang P, Cheng W, Sun X, Yuan J, Wang Q, Wang Y, Hong S, Shen H, Zhu D, Zhang Y, Dai F, Hang J, Li J, Hu H, Zhang Q. The Effect of Diabetes Management Shared Care Clinic on Glycated Hemoglobin A1c Compliance and Self-Management Abilities in Patients with Type 2 Diabetes Mellitus. Int J Clin Pract 2023; 2023:2493634. [PMID: 38187353 PMCID: PMC10771925 DOI: 10.1155/2023/2493634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 01/09/2024] Open
Abstract
Objective We aim to evaluate the impact of diabetes management shared care clinic (DMSCC) on glycated hemoglobin A1c (HbA1c) compliance and self-management abilities in patients with type 2 diabetes mellitus (T2DM). Methods This study was a prospective cohort study of patients with T2DM participating in the DMSCC. At baseline and after management, the HbA1c levels were measured, the HbA1c compliance rate were calculated, and the Summary of Diabetes Self-Care Activities-6 (SDSCA-6), Diabetes Empowerment Scale-DAWN Short Form (DES-DSF), and Problem Areas in Diabetes Scale-Five-item Short Form (PAID-5) were completed. These pre- and post-management data were compared. Results A total of 124 eligible patients were enrolled. After the diabetes management of DMSCC, the average HbA1c decreased and the HbA1c compliance rate increased significantly (P < 0.01). SDSCA-6 showed significant improvement in physical activity, glycemic monitoring, smoking (P < 0.01), and taking medication (P < 0.05). DES-DSF suggested a greater willingness to try to effectively treat diabetes (P < 0.05). PAID-5 indicated significant improvement in diabetes-related emotional distress. Conclusion DMSCC can help patients with T2DM reduce HbA1c, increase HbA1c compliance, improve diabetes self-management behaviors, empowerment, and diabetes-related emotional distress and serve as an effective exploration and practice of diabetes self-management education and support.
Collapse
Affiliation(s)
- Tian Jiang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Chao Liu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Ping Jiang
- Department of Outpatient Changjiang Road, The First Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui, China
| | - Wenjun Cheng
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Xiaohong Sun
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Jing Yuan
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Qiaoling Wang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Yanlei Wang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Shihui Hong
- Department of Outpatient Changjiang Road, The First Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui, China
| | - Haiyan Shen
- Department of Outpatient Changjiang Road, The First Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui, China
| | - Dongchun Zhu
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Yi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Fang Dai
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Jing Hang
- Beijing Health Technology Co., LTD, Beijing 100085, China
| | - Jiguo Li
- Beijing Health Technology Co., LTD, Beijing 100085, China
| | - Honglin Hu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China
| |
Collapse
|
5
|
Chartrand J, Shea B, Hutton B, Dingwall O, Kakkar A, Chartrand M, Poulin A, Backman C. Patient- and family-centred care transition interventions for adults: a systematic review and meta-analysis of RCTs. Int J Qual Health Care 2023; 35:mzad102. [PMID: 38147502 PMCID: PMC10750974 DOI: 10.1093/intqhc/mzad102] [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: 07/04/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023] Open
Abstract
Although patient centredness is part of providing high-quality health care, little is known about the effectiveness of care transition interventions that involve patients and their families on readmissions to the hospital or emergency visits post-discharge. This systematic review (SR) aimed to examine the evidence on patient- and family-centred (PFC) care transition interventions and evaluate their effectiveness on adults' hospital readmissions and emergency department (ED) visits after discharge. Searches of Medline, CINAHL, and Embase databases were conducted from the earliest available online year of indexing up to and including 14 March 2021. The studies included: (i) were about care transitions (hospital to home) of ≥18-year-old patients; (ii) had components of patient-centred care and care transition frameworks; (iii) reported on one or more outcomes were among hospital readmissions and ED visits after discharge; and (iv) were cluster-, pilot- or randomized-controlled trials published in English or French. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers. A narrative synthesis was performed, and pooled odd ratios, standardized mean differences, and mean differences were calculated using a random-effects meta-analysis. Of the 10,021 citations screened, 50 trials were included in the SR and 44 were included in the meta-analyses. Care transition intervention types included health assessment, symptom and disease management, medication reconciliation, discharge planning, risk management, complication detection, and emotional support. Results showed that PFC care transition interventions significantly reduced the risk of hospital readmission rates compared to usual care [incident rate ratio (IRR), 0.86; 95% confidence interval (CI), 0.75-0.98; I2 = 73%] regardless of time elapsed since discharge. However, these same interventions had minimal impact on the risk of ED visit rates compared to usual care group regardless of time passed after discharge (IRR, 1.00; 95% CI, 0.85-1.18; I2 = 29%). PFC care transition interventions containing a greater number of patient-centred care (IRR, 0.73; 95% CI, 0.57-0.94; I2 = 59%) and care transition components (IRR, 0.76; 95% CI, 0.64-0.91; I2 = 4%) significantly decreased the risk of patients being readmitted. However, these interventions did not significantly increase the risk of patients visiting the ED after discharge (IRR, 1.54; CI 95%, 0.91-2.61). Future interventions should focus on patients' and families' values, beliefs, needs, preferences, race, age, gender, and social determinants of health to improve the quality of adults' care transitions.
Collapse
Affiliation(s)
- Julie Chartrand
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
| | - Beverley Shea
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Moran Crescent, Ottawa, Ontario K1G 5Z3, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
- Bruyère Research Institute, Bruyère Continuing Care, 85 Primerose Avenue, Ottawa, Ontario K1R 6M1, Canada
| | - Brian Hutton
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Moran Crescent, Ottawa, Ontario K1G 5Z3, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Orvie Dingwall
- Neil John Maclean Health Sciences Library, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Anupriya Kakkar
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Mariève Chartrand
- Collège La Cité, 801 Aviation Parkway, Ottawa, Ontario K1K 4R3, Canada
| | - Ariane Poulin
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
| | - Chantal Backman
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
- Care of the Elderly, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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
Collapse
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
| |
Collapse
|
8
|
Amini F, Khorasani P, Ashrafi-rizi H. An explanation on the process of production to the utilization of patient education media in chronic diseases in Iran: Protocol for a grounded theory study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:193. [PMID: 37546023 PMCID: PMC10402767 DOI: 10.4103/jehp.jehp_525_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/23/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Chronic diseases are always considered one of the most critical challenges of the health system in any country. Patient education on self-care is one of the basic strategies in controlling the disease process and minimizing complications in patients with chronic diseases. It seems that in the process of patient education, from the preparation of materials to their delivery to the final user, many problems prevent the proper and practical education. The study aims to explain the process of production to the utilization of patient education media in chronic diseases in Iran. MATERIALS AND METHODS This study employs a grounded theory (GT) methodology and the data will be analyzed by Strauss and Corbin method. Participants in this study include groups involved in the field of patient education, including policymakers, managers at all management levels, clinical, educational, and public health service providers (physicians, nurses, medical librarians, medical, and nursing professors, NGOs in the field of patient education, physiotherapists, nutritionists, and psychologists) as well as service receivers such as patients, their family, and caregivers whom will be all selected through theoretical as well as snowball sampling method. The interview method will be semi-structured and will not be ceased until the data is saturated. CONCLUSIONS It is anticipated that in this study, the pros and cons of the process of production to utilization of patient education media will be identified and appropriate solutions to improve this process will be provided.
Collapse
Affiliation(s)
- Faezeh Amini
- Department of Medical Library and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvaneh Khorasani
- Nursing and Midwifery Care Research Center, Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Ashrafi-rizi
- Department of Medical Library and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Barradell AC, Gerlis C, Houchen-Wolloff L, Bekker HL, Robertson N, Singh SJ. Systematic review of shared decision-making interventions for people living with chronic respiratory diseases. BMJ Open 2023; 13:e069461. [PMID: 37130669 PMCID: PMC10163462 DOI: 10.1136/bmjopen-2022-069461] [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] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Shared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients' pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome). DESIGN We conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools. DATA SOURCES MEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023. ELIGIBILITY CRITERIA Trials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken. RESULTS Eight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies. CONCLUSIONS These findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice. PROSPERO REGISTRATION NUMBER CRD42020169897.
Collapse
Affiliation(s)
- Amy C Barradell
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- College of Medicine, Biological Sciences & Psychology, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Charlotte Gerlis
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUICD), University of Leeds, Leeds, UK
- Research Centre for Patient Involvement, Central Denmark Region and Aarhus University, Aarhus, Denmark
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| |
Collapse
|
11
|
Zong Q, Feng Z, Wang J, Zheng Z, Chen C, Feng D. Is shared decision-making a determinant of polypharmacy in older patients with chronic disease? A cross-sectional study in Hubei Province, China. BMC Geriatr 2023; 23:258. [PMID: 37118790 PMCID: PMC10148389 DOI: 10.1186/s12877-023-03968-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect of SDM on polypharmacy. The objective of this study was to compare the impact of SDM and other factors on polypharmacy in inpatients and community patients. Additionally, the study aimed to compare the impact of different decision types on polypharmacy in community patients. METHODS This is a population-based multicenter retrospective study conducted in Hubei Province, China. A cluster sampling approach was used to recruit 536 chronic disease inpatients from March to April 2019, and 849 community patients were recruited from April to June 2021. Propensity score weighting was used to control the confounding variables and determine the net effect of SDM on polypharmacy. RESULTS Among the 536 hospitalized patients, the prevalence of polypharmacy was 56.3%. A high level of SDM was significantly associated with a lower risk of polypharmacy. Patients with chronic illnesses aged 76 years and older and with an annual family income of 24,001-36,000 yuan were associated with a lower likelihood of polypharmacy (p < 0.05). Multimorbidity was often accompanied by the occurrence of multiple medication use. Among 849 community patients, the prevalence of polypharmacy was 21.8%. Among types of decision-making, informed and paternalistic decision-making showed a higher likelihood of polypharmacy compared with shared decision-making (P < 0.05). Male, older patients over 76 years of age, urban residents, annual household income of 12,001-24,000 yuan, and multimorbidity were associated with higher likelihood of polypharmacy (P < 0.05). Patients with an annual household income of 24,001-36,000 yuan, 36,001 yuan or more, and good medication compliance showed a lower likelihood of polypharmacy (P < 0.05). CONCLUSIONS The prevalence of polypharmacy is high among China's older population with chronic disease who should be paid more atthention by the healthcare providers. Additionaly, encouraging the patients' attendance in SDM, reducing paternalistic and informed decision-making during prescribing, improving patient medication compliance, and increasing the promotion and guidance of rational medication use for patients are essential to reduce polypharmacy in Chinese chronic disease patients.
Collapse
Affiliation(s)
- Qiao Zong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jia Wang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
12
|
Peters JB, Antons JC, Koolen EH, van Helvoort HAC, van Hees HWH, van den Borst B, Spruit MA, Vercoulen JH, van ’t Hul AJ. Patient activation is a treatable trait in patients with chronic airway diseases: An observational study. Front Psychol 2022; 13:947402. [PMID: 36275228 PMCID: PMC9581203 DOI: 10.3389/fpsyg.2022.947402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-management is key for reducing the burden of disease in chronical illness. However, applying self-management presupposes behavioral change. Sufficient knowledge, skills, confidence and motivation to make the needed behavior changes are important prerequisites. During the past years the Integral Diagnostic Trajectory was developed for patients with asthma or COPD which aims to identify treatable traits and activating patients for self-management. Objective In the present study the effects of the Integral Diagnostic Trajectory on the Patient Activation Measure (PAM®) were examined. In addition, predictive variables for PAM baseline scores and change scores were sought. Materials and methods A total of 241 patients with asthma or COPD referred to the pulmonologist at the Radboud university medical center, location Dekkerswald, Nijmegen were included. Patient activation was measured before the first visit and after the intervention with the 13-item PAM®. Additional, patient characteristics and health status were measured with the Nijmegen Clinical Screening Instrument (NCSI), modified Medical Research Council (mMRC), Asthma Control Questionnaire (ACQ), and COPD Clinical Questionnaire (CCQ). Results Fifty percent of the patients with asthma and seventy percent of the patients with COPD had low levels of activation at baseline (PAM level 1-2). Baseline PAM scores could be explained in patients with asthma for 7% by number of severe problems in health status. And for 18% in patients with COPD by number of severe problems, age and employment status. After the intervention both groups significantly improved on the PAM (T0: 56.0 ± 13.1 vs. T1:63.3 ± 14.0 in asthma, and T0: 50.0 ± 8.8 vs. 58.4 ± 11.1 in COPD). Multivariate stepwise regression analysis showed that only 24% of the change in score could be explained by baseline PAM score and being employed in patients with asthma, and 18% of the variance in change score could be predicted by baseline PAM score in COPD. Conclusion The present study showed that low level of activation is a common feature in patients with asthma and COPD. With a relatively short and seemingly simple intervention patients can reach higher levels of patient activation, which is a prerequisite for adopting self-management techniques in daily life.
Collapse
Affiliation(s)
- Jeannette B. Peters
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeanine C. Antons
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eleonore H. Koolen
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hanneke A. C. van Helvoort
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hieronymus W. H. van Hees
- Department of Pulmonary Diseases, Donders Institute for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Jan H. Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alex J. van ’t Hul
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
13
|
A Retrospective Study of Diaphragmatic Breathing Training Combined with Discharge Care Bundles in Patients with Chronic Obstructive Pulmonary Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9649986. [PMID: 36159577 PMCID: PMC9492362 DOI: 10.1155/2022/9649986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
Objective. Both physical exercise and discharge care bundles can improve patient outcomes and reduce hospitalization rates among subjects with chronic obstructive pulmonary disease (COPD). The retrospective analysis aims to determine the advantages of care bundles combined with diaphragmatic breathing training (DBT) in COPD patients after discharge. Methods. Of the 110 COPD patients, 55 patients received DBT alone (DBT group) and 55 participants received the combined intervention (care bundle + DBT group). Three months after discharge, we assessed the outcomes of patients using Bristol COPD Knowledge Questionnaire (BCKQ), Hospital Anxiety and Depression Scale (HADS), COPD Assessment Test (CAT), and St. George’s Respiratory Questionnaire (SGRQ). Meanwhile, COPD-related hospital readmissions were also recorded. Results. The BCKQ score for assessing the disease knowledge level was increased in patients at 3 months after the combined interventions as compared to the baseline values, which was higher in the care bundle + DBT group than the DBT group at 3 months. Moreover, improvements in negative emotion and clinical symptoms from baseline to 3-month follow-up were seen in both the two groups. Besides, the care bundle + DBT group showed the mitigation of depression and anxiety and the alleviation of clinical symptoms in comparison with the DBT group at 3 months. Participants who received combined interventions had lower SGRQ scores than those who received DBT alone. The time to first COPD-related readmission was shorter for patients in the care bundle + DBT group compared with the DBT group. Conclusions. DBT combined with discharge care bundles for COPD patients resulted in improvements in disease-specific knowledge, negative emotions, and clinical symptoms with better HRQOL and lower readmission rate.
Collapse
|
14
|
Zhang R, Lu H, Chang Y, Zhang X, Zhao J, Li X. Prediction of 30-day risk of acute exacerbation of readmission in elderly patients with COPD based on support vector machine model. BMC Pulm Med 2022; 22:292. [PMID: 35907836 PMCID: PMC9338624 DOI: 10.1186/s12890-022-02085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Acute exacerbation of chronic obstructive pulmonary disease (COPD) is an important event in the process of disease management. Early identification of high-risk groups for readmission and appropriate measures can avoid readmission in some groups, but there is still a lack of specific prediction tools. The predictive performance of the model built by support vector machine (SVM) has been gradually recognized by the medical field. This study intends to predict the risk of acute exacerbation of readmission in elderly COPD patients within 30 days by SVM, in order to provide scientific basis for screening and prevention of high-risk patients with readmission. Methods A total of 1058 elderly COPD patients from the respiratory department of 13 general hospitals in Ningxia region of China from April 2019 to August 2020 were selected as the study subjects by convenience sampling method, and were followed up to 30 days after discharge. Discuss the influencing factors of patient readmission, and built four kernel function models of Linear-SVM, Polynomial-SVM, Sigmoid-SVM and RBF-SVM based on the influencing factors. According to the ratio of training set and test set 7:3, they are divided into training set samples and test set samples, Analyze and Compare the prediction efficiency of the four kernel functions by the precision, recall, accuracy, F1 index and area under the ROC curve (AUC). Results Education level, smoking status, coronary heart disease, hospitalization times of acute exacerbation of COPD in the past 1 year, whether long-term home oxygen therapy, whether regular medication, nutritional status and seasonal factors were the influencing factors for readmission. The training set shows that Linear-SVM, Polynomial-SVM, Sigmoid-SVM and RBF-SVM precision respectively were 69.89, 78.07, 79.37 and 84.21; Recall respectively were 50.78, 69.53, 78.74 and 88.19; Accuracy respectively were 83.92, 88.69, 90.81 and 93.82; F1 index respectively were 0.59, 0.74, 0.79 and 0.86; AUC were 0.722, 0.819, 0.866 and 0.918. Test set precision respectively were86.36, 87.50, 80.77 and 88.24; Recall respectively were51.35, 75.68, 56.76 and 81.08; Accuracy respectively were 85.11, 90.78, 85.11 and 92.20; F1 index respectively were 0.64, 0.81, 0.67 and 0.85; AUC respectively were 0.742, 0.858, 0.759 and 0.885. Conclusions This study found the factors that may affect readmission, and the SVM model constructed based on the above factors achieved a certain predictive effect on the risk of readmission, which has certain reference value.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Hongyan Lu
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
| | - Yan Chang
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Xiaona Zhang
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Jie Zhao
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Xindan Li
- Department of Nursing, The General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| |
Collapse
|
15
|
Nohra RG, Chaaban T, Sacre H, Salameh P, Aoun Bacha Z, Le Bon Chami B, Abou Rizk F, Makhlouf P, Rothan-Tondeur M. Evaluating the Feasibility and Pretesting the Impact of an Educational and Telemonitoring Program for COPD Patients in Lebanon. Int J Chron Obstruct Pulmon Dis 2022; 17:949-965. [PMID: 35510164 PMCID: PMC9058009 DOI: 10.2147/copd.s339592] [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: 09/17/2021] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The objective of this study was to investigate the feasibility and pretest the effectiveness of an educational and telemonitoring program in a sample of Lebanese COPD patients to inform the design of a randomized study. Patients and Methods This study recruited a convenient sample of 15 patients from the pulmonology departments of four hospitals. Validated questionnaires were adapted to meet the context of this study in terms of adequacy, acceptability, adoption, fidelity, and cost. The impact of this program on quality of life and anxiety was measured by the COPD Assessment Test (CAT), the COPD Clinical Questionnaire (CCQ), and the Hospital Anxiety and Depression Scale (HADS). All measurements were performed before and after the intervention. Results All 15 participants who agreed to participate in this intervention found the program adequate and acceptable for addressing COPD-related issues. Regarding adoption, all participants declared having no difficulty explaining to others the content of the education sessions and that they would suggest this program to other COPD patients. In terms of effectiveness, six patients had improving in quality of life scores, and five patients had lower anxiety and depression scores compared to baseline measures. A knowledge assessment was done at the end of each session, showing an increase in knowledge for all participants. Skills were also assessed at the end of the program. Participants made no errors that had an impact on their health. Regarding the cost, it was difficult to evaluate the relative cost of this intervention given the economic situation in the country. Conclusion This study is the first to evaluate the application of telehealth to optimize COPD management in Lebanon. The approach proposed gave insights into the different obstacles and facilitating factors for implementing such a project to allow a large-scale work on the adaptation of the COPD patient to his disease in Lebanon.
Collapse
Affiliation(s)
- Rita Georges Nohra
- Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, Université Sorbonne Paris Nord, Villetaneuse, France
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, INSPECT-LB, Beirut, Lebanon
- Correspondence: Rita Georges Nohra, Université Sorbonne Paris Nord, Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, 74 Rue Marcel Cachin, Villetaneuse, 93000, France, Tel +961 76 144 873; +33 7 67 23 36 34, Email
| | - Taghrid Chaaban
- Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, Université Sorbonne Paris Nord, Villetaneuse, France
- Faculty of Public Health, Islamic University of Lebanon, Khaldeh - Beirut, Lebanon
| | - Hala Sacre
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, INSPECT-LB, Beirut, Lebanon
| | - Pascale Salameh
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, INSPECT-LB, Beirut, Lebanon
- School of Medicine, Lebanese Amerian University, Byblos, Lebanon
- Department of Research, Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, 2417, Cyprus
| | - Zeina Aoun Bacha
- Department of Pulmonary Disease,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Fadi Abou Rizk
- Department of Pulmonary Disease, American University Medical Center Rizk Hospital, Beirut, Lebanon
| | - Paul Makhlouf
- Department of Pulmonary Disease, Notre Dame du Liban Hospital, Jounieh, Lebanon
| | - Monique Rothan-Tondeur
- Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, Université Sorbonne Paris Nord, Villetaneuse, France
- Chaire Recherche Sciences Infirmières, AP-HP, Paris, France
| |
Collapse
|
16
|
Kang E, Chaboyer W, Tobiano G, Gillespie B. Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients' postdischarge recovery: a pilot randomised controlled trial. BMJ Open 2022; 12:e054038. [PMID: 35140156 PMCID: PMC8830258 DOI: 10.1136/bmjopen-2021-054038] [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: 11/25/2022] Open
Abstract
OBJECTIVE To assess the feasibility of implementing a web-based discharge education programme for general surgery patients both prior to and after hospital discharge. DESIGN, SETTING AND PARTICIPANTS This is a prospective, two-arm, pilot randomised controlled trial. Patients who had a general surgery procedure were recruited from a tertiary hospital between October 2020 and January 2021. Patients were randomly assigned to either the standard education or the web-based education intervention. INTERVENTION The web-based education comprised of three components designed to enhance patients' knowledge, skills and confidence to improve their engagement with self-care, and the ability to detect any postoperative issues that can arise during the postdischarge period. MAIN OUTCOMES AND MEASURES The primary outcome was feasibility in terms of recruitment, randomisation, retention and treatment fidelity related to intervention delivery, adherence and satisfaction. Secondary outcomes were patient activation, self-care ability and unplanned healthcare utilisation. RESULTS Eighty-five patients were recruited and randomised (42 control; 43 intervention). Twenty-three (27%) were lost to follow-up. All patients received their group allocation as randomised and all patients in the intervention group received the web-based education prior to discharge. Postdischarge, patients accessed the education an average of 3 times (SD 3.14), with 4 minutes (SD 16) spent on the website. 28 (97%) of the intervention patients found the content easy to understand, 25 (86%) found it useful and 24 (83%) were satisfied with its content. There was a significant association between the intervention and patient activation (F(1,60)=9.347, p=0.003), but not for self-care ability and unplanned healthcare utilisations. CONCLUSION This pilot study demonstrated the feasibility of implementing a web-based education programme. There was a high number of participants lost to follow-up, requiring additional attention in the design and implementation of a larger trial. TRIAL REGISTRATION NUMBER ACTRN12620000389909p.
Collapse
Affiliation(s)
- Evelyn Kang
- School of Nursing and Midwifery, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Georgia Tobiano
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brigid Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| |
Collapse
|
17
|
Shnaigat M, Downie S, Hosseinzadeh H. Effectiveness of patient activation interventions on chronic obstructive pulmonary disease self-management outcomes: A systematic review. Aust J Rural Health 2022; 30:8-21. [PMID: 35034409 DOI: 10.1111/ajr.12828] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease is the third leading cause of death worldwide. Although there is currently no cure for chronic obstructive pulmonary disease, the available self-management strategies can result in improving the symptoms, slowing the disease progression, reducing the frequency of acute exacerbations, improving the patients' quality of life and minimising health care utilisation-associated costs. Patient activation is often considered an essential driver of self-management; however, there are contradictory evidence about its impact on chronic obstructive pulmonary disease self-management. OBJECTIVE This review aims to fill this gap by collating the available evidence on the effectiveness of patient activation-driven chronic obstructive pulmonary disease self-management interventions. METHODS Databases including MEDLINE, Academic Search Complete, CINAHL Plus, Science Citation Index, Social Sciences Citation Index, Scopus, APA PsychInfo, EMBASE and ScienceDirect were searched for randomised controlled trials of patient activation-driven chronic obstructive pulmonary disease self-management interventions between 2004 and July 2020. The search terms included chronic obstructive pulmonary disease, self-management/self-care and patient activation/patient engagement. FINDINGS The initial search resulted in 645 articles, and after reviewing, 10 randomised controlled trials met the inclusion and exclusion criteria. Our review found that patient activation level had a positive association with chronic obstructive pulmonary disease self-management and clinical outcomes, and higher patient activation levels led to better outcomes. The interventions also led to moderate improvements in patient activation level. However, improved patient activation levels did not improve hospitalisation rates, quality of life and mental health. CONCLUSION Our findings suggest that patient activation can be used as a reliable tool for improving chronic obstructive pulmonary disease self-management and clinical outcomes; however, it should encompass all aspects of patient activation, especially the emotional aspect.
Collapse
Affiliation(s)
- Mahmmoud Shnaigat
- Faculty of Social Sciences, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Sue Downie
- Discipline of Medical and Exercise Science, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Hassan Hosseinzadeh
- Faculty of Social Sciences, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
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 .
Collapse
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
| |
Collapse
|
21
|
Shiwaku E, Dote S, Kaneko S, Hei C, Aikawa M, Sakai Y, Kawai T, Iwatsubo S, Hashimoto M, Tsuneishi T, Nishimura T, Iwata T, Hira D, Terada T, Nishimura T, Kobayashi Y. Pharmacist involvement in the inhaler choice improves lung function in patients with COPD: a prospective single-arm study. J Pharm Health Care Sci 2021; 7:28. [PMID: 34334137 PMCID: PMC8327440 DOI: 10.1186/s40780-021-00211-0] [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: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Currently, in Japan, shifting tasks from physician to hospital pharmacist is being developed to reduce physician workload and improve the quality of pharmacotherapy. This study aimed to investigate the effects of pharmacist involvement in the choice of inhaler as the task on the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD). Methods This prospective, single-center, single-arm study included 36 outpatients with newly diagnosed COPD indicating inhaler therapy. Eligible patients were immediately interviewed by pharmacist. Then, pharmacist assessed patient’s inhalation flow rate, physical function to handle an inhaler, comprehension, and value, and finally recommended a personalized inhaler based on originally developed inhaler choice protocol, and pulmonologist prescribed a pharmacist-selected inhaler. The primary endpoint was the improvement in trough forced expiratory volume in 1 s (FEV1) between baseline and week 26. The secondary endpoints were safety, and improvements at week 26 in scores for the COPD Assessment Test (CAT), modified British Medical Research Council Dyspnea Scale (mMRC), and Adherence Starts with Knowledge-20 (ASK-20). Results The pneumonologists completely agreed with the pharmacist-recommended inhaler. Mean FEV1 significantly increased from baseline to week 26 (1.60, SD 0.54 L vs. 1.98, SD 0.56 L; p < 0.0001). Significant improvements in CAT, mMRC, and ASK-20 scores were also observed. The prevalence of CAT responders as a negative predictor of acute exacerbation, defined as those with a decrease in CAT score of ≥2 points from baseline, was 86%. None of the patients experienced exacerbation during the study period. Conclusions Pharmacist involvement in the choice of inhaler for patients with newly diagnosed COPD was associated with improved lung function, health status, clinical symptoms, and adherence to inhaler therapy. Shifting task of choosing appropriate inhaler from physician to hospital pharmacist may be performed effectively and safely with an inhaler choice protocol. Trial registration number UMIN000039722, retrospectively registered on March 10, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s40780-021-00211-0.
Collapse
Affiliation(s)
- Eiji Shiwaku
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Satoshi Dote
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Shinobu Kaneko
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Chisato Hei
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Masaki Aikawa
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuki Sakai
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Takahiro Kawai
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Shigeaki Iwatsubo
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | | | - Teppei Tsuneishi
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Tomoko Nishimura
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Toshiyuki Iwata
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Daiki Hira
- Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan.,College of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Takashi Nishimura
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuka Kobayashi
- Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan
| |
Collapse
|
22
|
Kitzman H, DaGraca B, Mamun A, Collinsworth A, Halloran K, Masica A. Embedded Health Systems Science as a driver of care improvement within an integrated delivery organization. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100497. [PMID: 34175103 DOI: 10.1016/j.hjdsi.2020.100497] [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: 10/30/2019] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Embedded Health Systems Science (HSS) has the potential to reduce gaps between research and delivery of evidence-based medicine. Models are needed to guide the development of embedded HSS in health care delivery organizations particularly with the rise of value-based care. METHODS The development of HSS infrastructure at a large nonprofit health care delivery organization is described, along with an embedded HSS diabetes study to illustrate the integration of program specific data, electronic health records, and health care system data infrastructure. To compare diabetes outcomes across four evidenced-based programs, a control group was developed from EHR data using propensity score matching. Mixed effect adjusted models were used to estimate reductions in hemoglobin A1c (HbA1c) and body weight. RESULTS Adjusted analyses using an EHR derived comparison group demonstrated significantly different findings than unadjusted pre to post analyses. The embedded HSS study indicates that appropriate statistical methods, staff with required expertise, and integration with health system data infrastructure are needed to develop timely and rigorous HSS outcomes that effectively improve patient care. CONCLUSIONS Embedded HSS has the potential to inform value-based care models and contribute to evidence-based medicine approaches that improve patient care. Although developing system wide integrated data structures and staff with the appropriate skills requires substantial effort, the outcome is more reliable evaluations that lead to higher quality and higher value care. IMPLICATIONS Health care delivery organizations can improve patient care by dedicating resources to embed HSS into its routine operations.
Collapse
Affiliation(s)
- Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA.
| | - Briget DaGraca
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Ashley Collinsworth
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA
| | - Kenneth Halloran
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Andrew Masica
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA; Texas Health Resources, Arlington, TX, USA
| |
Collapse
|
23
|
Kang E, Tobiano GA, Chaboyer W, Gillespie BM. Nurses' role in delivering discharge education to general surgical patients: A qualitative study. J Adv Nurs 2020; 76:1698-1707. [PMID: 32281678 DOI: 10.1111/jan.14379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
AIMS To explore nurses' perceived role and experience in providing discharge education to general surgical patients. DESIGN Qualitative, using focus groups and face-to-face individual interviews. METHODS Purposive sampling with maximum variation was used to recruit nurses from the general surgical wards in a tertiary hospital in Queensland, Australia. Semi-structured interviews (three focus groups and four individual interviews) were conducted with 21 nurses involved in delivering postoperative discharge education from August 2018 - July 2019. Interview data were analysed using inductive content analysis. RESULTS Four themes emerged: assuming responsibility for patient education in the absence of discharge communication; supporting patients to participate in self-management after hospitalization; variability in the resources, content and delivery of discharge education; and meeting operational demands compromises the quality of patients' discharge education. CONCLUSION This study highlights the importance of nurses' role and the challenges encountered in delivering effective discharge education. These findings can be used to identify strategies to enhance discharge communication among health professionals and standardize the delivery of education to improve surgical patients' postoperative outcomes. IMPACT Ineffective discharge education contributes to patients' poor management of their postdischarge recovery. Developing an understanding of nurses' role in discharge education can inform policies and nursing practice to improve patients' well-being and reduce the potential for unplanned and emergency care.
Collapse
Affiliation(s)
- Evelyn Kang
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
| | - Georgia A Tobiano
- Nursing and Midwifery Education and Research Unit, The Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia.,Healthcare Practice and Survivorship Program, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, The Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| |
Collapse
|
24
|
Granados-Santiago M, Valenza MC, López-López L, Prados-Román E, Rodríguez-Torres J, Cabrera-Martos I. Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial. PATIENT EDUCATION AND COUNSELING 2020; 103:702-708. [PMID: 31859121 DOI: 10.1016/j.pec.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/06/2019] [Accepted: 12/09/2019] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a shared decision-making and patient engagement (SDM-PE) program concerning in-hospital stay during acute exacerbation of COPD and determine its impact on patients' perceived health status. METHODS Patients were randomly allocated to a control group that received standard treatment or an intervention group that received an individualized SDM-PE program in addition to standard treatment. The SDM-PE program included personalized health care focused on information about the disease, healthcare management, and reinforcement of behaviors regarding nutrition and exercise taking into account patients' preferences. RESULTS A comparative analysis between groups showed a significant improvement in perceived health status at discharge in patients included in the experimental group compared to those in the control group (60.28 ± 21.65 vs. 54.13 ± 22.69, p = 0.036). In addition, perceived health status, COPD knowledge, adherence to pharmacological treatment, general functionality, and healthy lifestyle measures were significantly better at 3-month follow-up in the intervention group. CONCLUSION An SDM-PE program significantly enhanced all the clinical measures assessed during hospitalization at 3-month follow-up. PRACTICE IMPLICATIONS COPD patients and professionals need to work together to select the best care and treatment model for patients, taking into account individual values and preferences.
Collapse
|
25
|
Kong CW, Wilkinson TM. Predicting and preventing hospital readmission for exacerbations of COPD. ERJ Open Res 2020; 6:00325-2019. [PMID: 32420313 PMCID: PMC7211949 DOI: 10.1183/23120541.00325-2019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
More than a third of patients hospitalised for acute exacerbation of COPD are readmitted to hospital within 90 days. Healthcare professionals and service providers are expected to collaboratively drive efforts to improve hospital readmission rates, which can be challenging due to the lack of clear consensus and guidelines on how best to predict and prevent readmissions. This review identifies these risk factors, highlighting the contribution of multimorbidity, frailty and poor socioeconomic status. Predictive models of readmission that address the multifactorial nature of readmissions and heterogeneity of the disease are reviewed, recognising that in an era of precision medicine, in-depth understanding of the intricate biological mechanisms that heighten the risk of COPD exacerbation and re-exacerbation is needed to derive modifiable biomarkers that can stratify accurately the highest risk groups for targeted treatment. We evaluate conventional and emerging strategies to reduce these potentially preventable readmissions. Here, early recognition of exacerbation symptoms and the delivery of prompt treatment can reduce risk of hospital admissions, while patient education can improve treatment adherence as a key component of self-management strategies. Care bundles are recommended to ensure high-quality care is provided consistently, but evidence for their benefit is limited to date. The search continues for interventions which are effective, sustainable and applicable to a diverse population of patients with COPD exacerbations. Further research into mechanisms that drive exacerbation and affect recovery is crucial to improve our understanding of this complex, highly prevalent disease and to advance the development of more effective treatments.
Collapse
Affiliation(s)
- Chia Wei Kong
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton, UK
| | - Tom M.A. Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University Hospital Southampton, Southampton, UK
| |
Collapse
|
26
|
Ma Y, Peng Y, Chen P, Nie N, Chen Y. Assessment of COPD-Related Knowledge Among Internal Medicine Nurses: A Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2917-2925. [PMID: 31908440 PMCID: PMC6925546 DOI: 10.2147/copd.s232055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background Since most internal medicine nurses work with chronic obstructive pulmonary disease (COPD) patients daily, their ability to meet the needs of COPD patients is an important issue. Our study aimed to assess COPD-related knowledge in internal medicine nurses. Methods A descriptive cross-sectional study including 175 participants was conducted to investigate COPD-related knowledge levels among internal medicine nurses in a large top-ranked tertiary hospital in China. The Bristol COPD Knowledge Questionnaire (BCKQ) was used to test COPD-related knowledge levels in the participants. Results Overall BCKQ score for all nurses in this study was 35.76 ± 5.49. In comparison with non-respiratory nurses, the overall score among respiratory nurses was significantly higher (39.01 ± 3.95 vs 33.32 ± 5.23, p < 0.001). The mean scores for four topics (epidemiology, breathlessness, oral steroids, and inhaled steroids) were less than 3 among both respiratory and non-respiratory nurses. Subgroup analysis of specialist respiratory wards showed that nurses in the chronic airway disease ward had the highest overall knowledge score (40.47 ± 4.03). Linear regression analysis demonstrated that the overall BCKQ score was significantly related to the population of nurses (β coefficient = 3.016, 95% confidence interval [CI]: 0.953-5.079, p < 0.01), education (β coefficient = 4.710, 95% CI: 1.979-7.440, p < 0.01) and previous rotation in respiratory wards (β coefficient = 3.871, 95% CI: 1.776-5.967, p < 0.001). Conclusion Internal medicine nurses at this tertiary hospital showed deficits in COPD-related knowledge. Appropriate and systematic education about COPD knowledge and strengthening rotation among different wards are necessary for improving COPD-related knowledge levels among internal medicine nurses.
Collapse
Affiliation(s)
- Yiming Ma
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People's Republic of China
| | - Yating Peng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People's Republic of China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People's Republic of China
| | - Na Nie
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People's Republic of China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People's Republic of China
| |
Collapse
|
27
|
COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:103-119. [PMID: 31502238 DOI: 10.1007/s40271-019-00386-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. METHODS We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPD patients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. RESULTS Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). CONCLUSIONS Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits. CLINICAL TRIALS REGISTRATION NO NCT02870998.
Collapse
|
28
|
Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis. Int J Nurs Stud 2019; 101:103396. [PMID: 31698168 DOI: 10.1016/j.ijnurstu.2019.103396] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term. OBJECTIVE To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge. DESIGN Meta-analysis of randomized controlled trials. DATA SOURCES A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits. REVIEW METHODS RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model. RESULTS Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity. CONCLUSIONS Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.
Collapse
|