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O'Sullivan DJ, Bearne LM, Harrington JM, Cardoso JR, McVeigh JG. The effectiveness of social prescribing in the management of long-term conditions in community-based adults: A systematic review and meta-analysis. Clin Rehabil 2024; 38:1306-1320. [PMID: 38863236 DOI: 10.1177/02692155241258903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to evaluate the effectiveness of social prescribing interventions in the management of long-term conditions in adults. DATA SOURCES Eleven electronic databases were searched for randomised and quasi-randomised controlled trials. REVIEW METHODS Outcomes of interest were quality of life, physical activity, psychological well-being and disease-specific measures. Bias was assessed with the Cochrane Risk of Bias 2 tool. A narrative synthesis and meta-analysis were performed. RESULTS Twelve studies (n = 3566) were included in this review. Social prescribing interventions were heterogeneous and the most common risks of bias were poor blinding and high attrition. Social prescribing interventions designed to target specific long-term conditions i.e., cancer and diabetes demonstrated significant improvements in quality of life (n = 2 studies) and disease-specific psychological outcomes respectively (n = 3 studies). There was some evidence for improvement in physical activity (n = 2 studies) but most changes were within group only (n = 4 studies). Social prescribing interventions did not demonstrate any significant changes in general psychological well-being. CONCLUSION Social prescribing interventions demonstrated some improvements across a range of outcomes although the quality of evidence remains poor.
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Affiliation(s)
- Declan J O'Sullivan
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lindsay M Bearne
- Population Health Research Institute, St George's, University of London, London, UK
| | - Janas M Harrington
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jefferson R Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, Universidade Estadual de Londrina, Brazil
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Ma X, Wang Y, Chen Y, Lian Y, Zhao X, He X, Qiu Y, Han S, Liu L, Wang C. Association between medication complexity and follow-up care attendance: insights from a retrospective multicenter cohort study across 1,223 Chinese hospitals. Front Pharmacol 2024; 15:1448986. [PMID: 39135802 PMCID: PMC11317271 DOI: 10.3389/fphar.2024.1448986] [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] [Received: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently face substantial medication burdens. Follow-up care on medication management is critical in achieving disease control. This study aimed to analyze the complexity of COPD-specific medication and determine how it impacted patients' attendance on follow-up care. Methods This multicenter study includes patients with COPD from 1,223 hospitals across 29 provinces in China from January 2021 to November 2022. The medication Regimen Complexity Index (MRCI) score was used to measure COPD-specific medication complexity. The association between medication complexity and follow-up care attendance was evaluated using the Cox Proportional Hazard Model. Results Among 16,684 patients, only 2,306 (13.8%) returned for follow-up medication management. 20.3% of the patients had high complex medication regimen (MRCI score >15.0). The analysis revealed that compared to those with less complex regimens, patients with more complex medication regimens were significantly less likely to attend the follow-up medication care, with a Hazard Ratio (HR) of 0.82 (95% Confidence Interval [CI], 0.74-0.91). Specifically, patients with more complex dosage forms were 51% less likely to attend the follow-up care (95% CI, 0.43-0.57). This pattern was especially marked among male patients, patients younger than 65 years, and those without comorbid conditions. Conclusion Higher medication complexity was associated with a decreased likelihood of attending follow-up care. To promote care continuity in chronic disease management, individuals with complex medication regimens should be prioritized for enhanced education. Furthermore, pharmacists collaborating with respiratory physicians to deprescribe and simplify dosage forms should be considered in the disease management process.
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Affiliation(s)
- Xuedi Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Department of Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongwu Chen
- Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yufei Lian
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaoyu Zhao
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuan He
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Qiu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lihong Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 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, Beijing, China
- Center of Respiratory Medicine, China-Japan Friendship Hospital, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Liang H, Hou J, Xiong J. Effect of Family-Centered Empowerment Model in Home Care of Older Adult Patients After Total Knee Arthroplasty. J Community Health Nurs 2024; 41:162-174. [PMID: 37921367 DOI: 10.1080/07370016.2023.2276744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE In the present study, we investigated the effect of the family-centered empowerment model (FCEM) in the home care of older adult patients after total knee arthroplasty (TKA). DESIGN The current study was a randomized controlled study. METHODS Two hundred eighty older adult patients who underwent TKA in our hospital from December 2020 to December 2022 were selected. They were divided into intervention and control groups using the random number table method, with 140 cases in each group. After follow-up and attrition, 133 patients were assigned to the intervention group and 130 to the control group. The control group received conventional care, and the intervention group received the care provided using the FCEM. The general characteristics of the study subjects were compiled using a general information questionnaire designed by the researcher. The chi-square test and t-test were used to compare the changes in self-care efficacy, knee function, and the occurrence of postoperative complications in the two groups before and after the intervention. FINDINGS The results suggest that the adoption of FCEM improved patient motivation and self-care efficacy, promoted the recovery of knee function in the short term after surgery, and reduced the likelihood of occurrence of complications. CONCLUSION The present study highlights the importance of extending the FCEM to multiple domains to fill the gaps in the currently available medical care system for older adults. In addition, the study provides a reference basis for reducing the occurrence of complications and improving patient prognosis. CLINICAL EVIDENCE The FCEM model is an effective strategy to improve the effectiveness of home nursing for older adults.
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Affiliation(s)
- Huijuan Liang
- Department of Orthopedics, Third People's Hospital of Nantong City, Nantong, China
| | - Jianwei Hou
- Department of Orthopedics, Third People's Hospital of Nantong City, Nantong, China
| | - Jing Xiong
- Department of Orthopedics, Third People's Hospital of Nantong City, Nantong, China
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Fernández-Villar A, Cimas Hernando JE, Figueira Gonçalves JM, De Miguel Díez J. Continuity of Care in Chronic Obstructive Pulmonary Disease Exacerbations: Challenges and Priorities. Arch Bronconeumol 2024; 60:327-329. [PMID: 38514349 DOI: 10.1016/j.arbres.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Alberto Fernández-Villar
- Respiratory Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain; NeumoVigo I+i Research Group, Southern Galician Institute of Health Research (IISGS), Vigo, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Juan Marco Figueira Gonçalves
- Respiratory Department, Research Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain; Canary Tropical Disease and Public Health Institute, La Laguna University, La Laguna, Spain
| | - Javier De Miguel Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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Alghamdi SM. Content, Mechanism, and Outcome of Effective Telehealth Solutions for Management of Chronic Obstructive Pulmonary Diseases: A Narrative Review. Healthcare (Basel) 2023; 11:3164. [PMID: 38132054 PMCID: PMC10742533 DOI: 10.3390/healthcare11243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Telehealth (TH) solutions for Chronic Obstructive Pulmonary Disease (COPD) are promising behavioral therapeutic interventions and can help individuals living with COPD to improve their health status. The linking content, mechanism, and outcome of TH interventions reported in the literature related to COPD care are unknown. This paper aims to summarize the existing literature about structured TH solutions in COPD care. We conducted an electronic search of the literature related to TH solutions for COPD management up to October 2023. Thirty papers presented TH solutions as an innovative treatment to manage COPD. TH and digital health solutions are used interchangeably in the literature, but both have the potential to improve care, accessibility, and quality of life. To date, current TH solutions in COPD care have a variety of content, mechanisms, and outcomes. TH solutions can enhance education as well as provide remote monitoring. The content of TH solutions can be summarized as symptom management, prompt physical activity, and psychological support. The mechanism of TH solutions is manipulated by factors such as content, mode of delivery, strategy, and intensity. The most common outcome measures with TH solutions were adherence to treatment, health status, and quality of life. Implementing effective TH with a COPD care bundle must consider important determinants such as patient's needs, familiarity with the technology, healthcare professional support, and data privacy. The development of effective TH solutions for COPD management also must consider patient engagement as a positive approach to optimizing implementation and effectiveness.
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Affiliation(s)
- Saeed Mardy Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia
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Peiffer S, Mehl SC, Powell P, Haltom TM, Lee TC, Keswani SG, King A. Maternal Anxiety and Empowerment in Pregnancies Complicated By Fetal Surgical Anomalies: A Mixed Methods Study. J Surg Res 2023; 292:22-29. [PMID: 37572410 DOI: 10.1016/j.jss.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Fetal surgical anomalies cause significant anxiety. Following the diagnosis, prenatal counseling with shared decision-making occurs. Empowerment is an essential component of shared decision-making. The purpose of this mixed-methods study was to evaluate the association between patient empowerment with depression and anxiety among patients with fetal surgical anomalies. METHODS An explanatory mixed-methods study was conducted at a large tertiary fetal center among patients with recently diagnosed surgical fetal anomalies from May, 2021 to May, 2022. Validated cross-sectional surveys were used to collect quantitative data regarding patient empowerment, depression, and anxiety. Univariate analysis was used to compare the association of maternal empowerment with depression and anxiety. Qualitative data was obtained from semistructured interviews to explore maternal anxiety and depression relative to the fetal diagnosis. Thematic analysis was performed to identify themes. RESULTS Seventy-four patients were recruited for the quantitative study. Pregnancy-related empowerment score and patient empowerment score were significantly lower for expectant mothers with high anxiety (P < 0.01). Eighteen patients participated in qualitative interviews. Participants expressed significant anxiety related to their fetal diagnosis. Exacerbating stressors included social determinants, personal history of miscarriage, and changing family dynamics. CONCLUSION Our results suggest there is an association between increased depression and anxiety with lower empowerment. These findings have important implications for prenatal counseling, as targeted interventions to improve psychosocial support to treat depression and anxiety might also improve empowerment.
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Affiliation(s)
- Sarah Peiffer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Steven C Mehl
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Paulina Powell
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Trenton M Haltom
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine, Houston, Texas
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
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Willard-Grace R, Hessler D, Huang B, DeVore D, Chirinos C, Wolf J, Low D, Garvey C, Donesky D, Tsao S, Thom DH, Su G. Pulmonary Specialist-Supported Health Coaching Delivered by Lay Personnel Improves Receipt of Quality Care for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. J Patient Cent Res Rev 2023; 10:201-209. [PMID: 38046991 PMCID: PMC10688918 DOI: 10.17294/2330-0698.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting. Methods As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care personnel informed by a pulmonary specialist practitioner. Outcome measures included prescription of appropriate inhaler therapy, participation in COPD-related education, engagement with specialty care, prescription of smoking cessation medications, and patient ratings of the quality of care. Results Baseline quality measures did not differ between study arms. At 9 months, coached patients were more likely (increase of 9.3% over usual care; P=0.014) to have received guideline-based inhalers compared to those in usual care. Coached patients were more likely to engage with pulmonary specialty care (increase of 8.3% over usual care with at least 1 visit; P=0.04) and educational classes (increase of 5.3% over usual care; P=0.03). Receipt of smoking cessation medications among patients smoking at baseline in the health coaching group increased 21.1 percentage points more than in usual care, a difference near statistical significance (P=0.06). Conclusions Health coaching may improve the provision of quality chronic illness care for conditions such as COPD.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | - Beatrice Huang
- Division of HIV, Infectious Disease and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Denise DeVore
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Devon Low
- independent consultant
- patient research partner
| | | | - DorAnne Donesky
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA
| | - David H. Thom
- Primary Care and Population Health, Stanford University, Stanford, CA
| | - George Su
- Division of Pulmonology, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA
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Anderson E, Wiener RS, Molloy-Paolillo B, McCullough M, Kim B, Harris JI, Rinne ST, Elwy AR, Bokhour BG. Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration's Whole Health System of Care. PLoS One 2023; 18:e0286326. [PMID: 37352241 PMCID: PMC10289382 DOI: 10.1371/journal.pone.0286326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. OBJECTIVES We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. DESIGN We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. KEY RESULTS Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. CONCLUSIONS Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- The Pulmonary Center and Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. Irene Harris
- VA Maine Healthcare System, Lewiston, Maine, United States of America
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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Empowering Self-Efficacy by Using Patient Empowerment among Chronic Obstructive Pulmonary Disease: Pre-Post-Test Study. Healthcare (Basel) 2023; 11:healthcare11030430. [PMID: 36767005 PMCID: PMC9914704 DOI: 10.3390/healthcare11030430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Patient empowerment is increasingly acknowledged as a milestone of high-quality patient-centered care. This study was conducted using COPD Self-Efficacy Scale to determine the effectiveness of the patient empowerment intervention program among chronic obstructive pulmonary disease patients on self-efficacy. We employed an interventional design with a pre-test and post-test. Sixty COPD patients comprised the final sample of the study. The current study revealed significant improvement in overall self-efficacy factors among most participants. Statistically significant positive correlations were found between the total self-efficacy post-empower intervention model scores concerning age, sex, work, educational level, and marital status. The study's findings revealed that the patient empowerment intervention program positively affected COPD patients' self-efficacy.
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Stellefson M, Kinder C, Boyd I, Elijah O, Naher S, McFadden N. COPD Self-Management for Adults Living in Rural Areas: Systematic Review of Telehealth and Non-Telehealth Interventions. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Wu DTY, Murdock P, Vennemeyer S, Mynatt JM, Chih MY. Challenges in inpatient care coordinators’ clinical workflow and opportunities in designing a health IT solution: A mixed methods study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221111004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.
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Affiliation(s)
- Danny TY Wu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul Murdock
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott Vennemeyer
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janie M Mynatt
- Department of Social Work, Care Management and Spiritual Care, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ming-Yuan Chih
- Department of Clinical Leadership and Management, University of Kentucky College of Health Sciences, Lexington, KY, USA
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Figueira-Gonçalves JM, Hernández-Pérez JM, Cabrera-López C, Wangüemert-Pérez AL, García-Talavera I, Ramallo-Fariña Y, Ramos-Izquierdo C, González-García LM, Guanche-Dorta S. Characteristics of patients referred to Canary Island pneumology outpatient services for chronic obstructive pulmonary disease: the EPOCan study. BMC Res Notes 2022; 15:36. [PMID: 35144675 PMCID: PMC8830167 DOI: 10.1186/s13104-022-05930-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Assessing patients with chronic obstructive pulmonary disease (COPD) accounts for 30% of all pneumology outpatient evaluations. COPD is a heterogeneous disease and generates a massive public health problem. Overall morbidity, particularly cardiovascular disease, challenges patient management. This is an observational, multicentre study, performed at four hospitals in the Canary Islands (Spain), aimed at characterising patients with COPD referred to pneumology outpatient services. Demographic variables, lung function, and morbidity were assessed. Results Of the 877 included patients, 44.9% were active smokers with a mean (± SD) age of 68.2 ± 10.3 years. The median (IQR) score for the Charlson comorbidity index was 2 (2), and 70.6% of the patients were assigned high risk according to the Spanish Guidelines for COPD (GesEPOC) 2021. The degree of airflow obstruction defined by the GOLD 2021 stages 1, 2, 3, and 4 corresponded to 13.6%, 49%, 31%, and 6.3% of patients, respectively. The most frequently associated morbidities were arterial hypertension (59.5%), dyslipidaemia (54.3%), and type 2 diabetes mellitus (31.2%); 32% of the patients suffered heart disease. There is a high prevalence of active smoking, type 2 diabetes mellitus, and heart disease in patients referred for COPD to Canary Island pneumology outpatient services. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05930-7.
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Affiliation(s)
- Juan Marco Figueira-Gonçalves
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. .,University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain.
| | - José María Hernández-Pérez
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio García-Talavera
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Foundation of the Canary Islands Health Research Institute (FIISC), Santa Cruz de Tenerife, SpainHealth Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Carolina Ramos-Izquierdo
- Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Manuel González-García
- Primary Care Centre of the Canary Islands Public Health Service, Breña Baja, La Palma, Santa Cruz de Tenerife, Spain
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13
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Rose EK, O'Connor J. "Addressing Advance Care Planning in Patients with COPD". Chest 2021; 161:676-683. [PMID: 34762924 DOI: 10.1016/j.chest.2021.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive debilitating disease with diminished quality of life after COPD hospital admissions. Due to the nature of the disease, it is important to address patients' goals of care, preferably prior to the development of refractory COPD. Advance Care Planning (ACP) is an all-encompassing term that involves discussing goals with patients. Various review articles on ACP and COPD focus on defining ACP, identifying barriers to addressing ACP, and using interventions to incorporate ACP in practice. There is evidence that ACP improves quality of communication, reduces admissions, and increases quality of life, but often the focus of that research has been on patients with cancer. Many of the articles have suggestions for how to apply ACP to chronic lung disease, but without further research and definitive guidance it may be difficult to obtain funding for programs dedicated to ACP. There are currently no guidelines for addressing ACP in patients with COPD. Research addresses why advance care planning is important, yet there are barriers that patients, families, and healthcare providers encounter, preventing meaningful discussions. Research has also found that utilizing multidisciplinary teams improves care and quality of life, yet research should be dedicated to investigating the effects of advance care planning initiatives on outcomes in patients with COPD, particularly in reducing hospital admissions and improving quality of life. This review seeks to educate providers about end-stage COPD and advance care planning, the evidence demonstrating advance care planning's importance, and the current and future state of research.
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Affiliation(s)
- Emily K Rose
- Virginia Commonwealth University School of Medicine.
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14
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Abstract
Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.
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Affiliation(s)
- Tanja Fusi-Schmidhauser
- Palliative and Supportive Care Clinic, IOSI-EOC and Department of Internal Medicine, Ospedale Regionale di Lugano, Lugano
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15
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Young M, Villgran V, Ledgerwood C, Schmetzer A, Cheema T. Developing a Multidisciplinary Approach to the COPD Care Pathway. Crit Care Nurs Q 2021; 44:121-127. [PMID: 33234865 DOI: 10.1097/cnq.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized as a predominately preventable and treatable inflammatory lung disease caused by progressive obstructed airflow from the lungs. In the United States and worldwide, it is becoming a major cause in hospital admissions as well as an increase in morbidity and mortality. The rising total cost of care for COPD is concerning for all health care industries. The disease has significant impact on the patient's quality of life and psychological well-being. A worldwide initiative is underway in developing a care model that is multifactorial through continuous monitoring of patients to manage and control symptoms, achieve medication adherence, and provide socioeconomic resources. The primary aim of this study was to prevent exacerbations, hospital admissions, and readmissions. Various models have shown positive results; however, the significant financial investment is the major barrier to success. Recently, one health system in the United States was able to improve care, decrease readmissions, and reduce total cost of care by investing in a multidisciplinary team of specialists. In the utilization of the care model, the primary endpoint will conclude that COPD is financially and socioeconomically manageable.
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Affiliation(s)
- Meilin Young
- Division of Pulmonary Critical Care Medicine (Drs Young, Villgran, Schmetzer, and Cheema) and Medicine Institute (Dr Ledgerwood), Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania
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16
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Hartford W, Asgarova S, MacDonald G, Berger M, Cristancho S, Nimmon L. Macro and meso level influences on distributed integrated COPD care delivery: a social network perspective. BMC Health Serv Res 2021; 21:491. [PMID: 34024272 PMCID: PMC8141100 DOI: 10.1186/s12913-021-06532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. Continuity of care is also emphasised. However, many patients with COPD experience fragmented care. Discontinuities in healthcare and related social services are likely to result in disjointed rather than integrated care which can negatively affect patient health outcomes. The purpose of this qualitative study was to improve our understanding of, and how, contextual features pertaining to structures and processes of COPD integrated care influence delivery of care within patients’ healthcare networks. Methods We conducted individual interviews with 28 participants (9 patients, 16 healthcare professionals, and 3 spousal caregivers). Participants were recruited through the lung clinic at a city hospital in western Canada. We employed a social network paradigm to analyse and interpret the data. Results The analysis revealed an overarching theme of fragmented COPD care with two sub-themes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways. The overarching theme depicts variations, delays, and discontinuities in patient care. The sub-themes describe how macro level influences and meso level shortfalls were perceived to influence the availability of respiratory care resources that contributed to fragmented COPD care. Conclusions Employing a social network lens drew particular attention to family physicians’ pivotal role in delivering community-based COPD care. While an integrated approach to care is recommended by care guidelines, institutional and organizational structures and processes, such as financial and communication structures, may inhibit delivery of integrated care. Thus, macro and meso level structures and processes have the potential to shape patient care by constraining family physicians’ purposive and communication actions necessary for facilitating an integrated distributed approach to care. We propose a context of care which fosters a context for family physicians’ delivery of patient-centered care. Integrated care delivery may improve patients’ wellbeing and alleviate financial constraints on the healthcare system.
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Affiliation(s)
- Wendy Hartford
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.
| | - Sevinj Asgarova
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,University of British Columbia, Vancouver, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, 429-2194, Health Sciences Mall, V6T 1Z3, Vancouver, Canada
| | - Graham MacDonald
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Mary Berger
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Dalhousie University, Halifax, Canada
| | - Sayra Cristancho
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario Canada, Medical Sciences Building, Suite 100, N6G 2V4, London, Ontario, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, BC, V6T 2B5, Vancouver, Canada.,Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, 429-2194, Health Sciences Mall, V6T 1Z3, Vancouver, Canada
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17
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Abstract
Chronic obstructive pulmonary disease (COPD) has a profound impact on people living with the disease and has a high global economic and social burden. Often, people with COPD are undiagnosed, while those diagnosed are undertreated and undereducated on different aspects of COPD care. Although there are many published evidence-based treatment guidelines from different expert groups and societies, they are frequently not adhered to, which results in significant gaps in care. In particular, 'flare-ups' (known as exacerbations of COPD), which accelerate disease progression, are often under-reported, despite guidelines recommending an escalation of maintenance treatment to prevent subsequent flare-ups. Management of COPD should be proactive to prevent worsening of symptoms and to reduce the risk of future flare-ups and premature death, rather than a secondary reaction to a worsening health status. Key to this is patient access to accurate diagnosis, effective treatment and specialist care, which can vary widely due to socioeconomic differences, geographical locations and poor guideline implementation. In addition, the stigma associated with COPD can act as a barrier, which can result in people being reluctant to access treatment or clinicians being nihilistic. As global patient advocates, we have co-developed this patient charter to set a standard of care that people living with COPD should expect, raising awareness and understanding of the causes and consequences of COPD as well as the potential to improve patient care. Patients with COPD should be empowered to live the highest quality of life possible with the least number of flare-ups. We set out six principles in line with current COPD guideline recommendations, that should be implemented by governments, healthcare providers, policymakers, lung health industry partners and patients/caregivers to drive meaningful change in COPD care.
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18
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Devi R, Kanitkar K, Narendhar R, Sehmi K, Subramaniam K. A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries. Adv Ther 2020; 37:4808-4830. [PMID: 33052560 PMCID: PMC7553852 DOI: 10.1007/s12325-020-01519-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Low- and middle-income countries (LMICs) are challenged with a disproportionately high burden of noncommunicable diseases (NCDs) and limited healthcare resources at their disposal to tackle the NCD epidemic. Understanding the patient journey for NCDs from the patients' perspective can help healthcare systems in these settings evolve their NCD care models to address the unmet needs of patients, enhance patient participation in their management, and progress towards better outcomes and quality of life. This paper aims to provide a theoretical framework outlining common touchpoints along the patient journey for NCDs in LMICs. It further aims to review influencing factors and recommend strategies to improve patient experience, satisfaction, and disease outcomes at each touchpoint. The co-occurrence of major NCDs makes it possible to structure the patient journey for NCDs into five broad touchpoints: awareness, screening, diagnosis, treatment, and adherence, with integration of palliative care along the care continuum pathway. The patients' perspective must be considered at each touchpoint in order to inform interventions as they experience first-hand the impact of NCDs on their quality of life and physical function and participate substantially in their disease management. Collaboratively designed health communication programs, shared decision-making, use of appropriate risk assessment tools, therapeutic alliances between the patient and provider for treatment planning, self-management tools, and improved access to palliative care are some strategies to help improve the patient journeys in LMICs. Long-term management of NCDs entails substantial self-management by patients, which can be augmented by pharmacists and nurse-led interventions. The digital healthcare revolution has heralded an increase in patient engagement, support of home monitoring of patients, optimized accurate diagnosis, personalized care plans, and facilitated timely intervention. There is an opportunity to integrate digital technology into each touchpoint of the patient journey, while ensuring minimal interruption to patients' care in the face of global health emergencies.
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Community social determinants and health outcomes drive availability of patient-centered medical homes. Health Place 2020; 67:102439. [PMID: 33212394 DOI: 10.1016/j.healthplace.2020.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, United States
| | - Rebecca Wilkerson
- Institute for Families in Society, University of South Carolina, United States
| | | | - Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, United States.
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20
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Jo HS, Jeong S, Kim WJ, Park S, Yu SA. Development of a Transitional Care Model Program for Patients with Pneumonia, Asthma, and Chronic Obstructive Pulmonary Disease: In-depth Interviews with Readmitted Patients. J Korean Med Sci 2020; 35:e352. [PMID: 33140589 PMCID: PMC7606884 DOI: 10.3346/jkms.2020.35.e352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
Community-based health management policies are needed considering societal aging. We aimed to develop a transitional care model (TCM) program for patients with pneumonia, asthma, and chronic obstructive pulmonary disease. First, we conducted in-depth interviews with patients who were hospitalized, released, and readmitted for those three conditions to identify issues with the current hospitalization/discharge system and post-discharge processes. Next, we developed a new TCM program suited to the realities of the current medical environment. Interviews revealed problems including inadequate awareness of disease and health management; insufficient information exchange between patients, caregivers, and primary medical institutions; and absence/low usage of community-based care services. The investigation applying the new TCM program to patients and following up on readmission rates and life satisfaction after discharge is ongoing. Reviewing these results and conducting further studies in the future will allow improvements to the model.
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Affiliation(s)
- Heui Sug Jo
- Department of Public Health Services, Kangwon National University Hospital, Chuncheon, Korea
- Department of Health Policy and Management, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seungmin Jeong
- Department of Public Health Services, Kangwon National University Hospital, Chuncheon, Korea.
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seolhyang Park
- Department of Public Health Services, Kangwon National University Hospital, Chuncheon, Korea
| | - Seol Ae Yu
- Department of Public Health Services, Kangwon National University Hospital, Chuncheon, Korea
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21
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Steurer-Stey C. [Implementing Chronic Care for Patients with COPD in Switzerland]. PRAXIS 2020; 109:788-793. [PMID: 32752963 DOI: 10.1024/1661-8157/a003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Implementing Chronic Care for Patients with COPD in Switzerland Abstract. Effective COPD disease management needs an approach that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems, where patient counseling, coordination and standardization of care are key components. This article reports about COPD chronic care approaches in Switzerland.
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Affiliation(s)
- Claudia Steurer-Stey
- Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich und
- medix Gruppenpraxis, Zürich
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22
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Graffigna G, Barello S, Riva G, Corbo M, Damiani G, Iannone P, Bosio AC, Ricciardi W. Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114167. [PMID: 32545278 PMCID: PMC7312656 DOI: 10.3390/ijerph17114167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022]
Abstract
Patient engagement has been recognized as a key priority in chronic care. However, scholars agree that guidelines are needed to ensure effective patient engagement strategies. To this end, a Consensus Conference process was promoted with the following methodological steps: (1) extensive literature review about patient engagement initiatives in chronic care; (2) a stakeholders survey to collect best practices and (3) workshops with experts. On the basis of the information collected, a consensus statement was drafted, revised, and finalized by a panel of select renowned experts. These experts agreed in defining engagement as an eco-systemic concept involving multiple actors all of which contribute to influence patients’ willingness and ability to engage in chronic care. Moreover, experts recommended, whenever possible, to adopt standardized instruments to assess engagement levels and related unmet needs. Then, experts strongly advised appropriate trainings for healthcare professionals about patient engagement strategies. Furthermore, the importance of promoting healthcare professionals’ wellbeing has been advocated. Family caregivers, as well as patients’ organizations - should be trained and engaged to increase the effectiveness of interventions dedicated to patients. Finally, experts agreed that digital technologies should be considered as a crucial enhancer for patient engagement in chronic care.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Correspondence: (G.G.); (S.B.); Tel.: +39-0272343863 (S.B.)
| | - Serena Barello
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Correspondence: (G.G.); (S.B.); Tel.: +39-0272343863 (S.B.)
| | - Giuseppe Riva
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
| | - Massimo Corbo
- Casa di Cura Privata del Policlinico, 20100 Milan, Italy;
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A., Gemelli IRCCS, 00168 Roma, Italy; (G.D.); (W.R.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | - Albino Claudio Bosio
- EngageMinds Hub – Consumer, Food and Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (G.R.); (A.C.B.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | - Walter Ricciardi
- Fondazione Policlinico Universitario A., Gemelli IRCCS, 00168 Roma, Italy; (G.D.); (W.R.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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To KW, Lee IF, Choi KC, Cheung YTY, Yu DS. An information‐motivation‐behavioural‐based model and adherence to inhalation therapy and other health outcomes in patients with chronic obstructive pulmonary disease: A pilot randomized controlled trial. Int J Nurs Pract 2020; 26:e12799. [DOI: 10.1111/ijn.12799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 09/01/2019] [Accepted: 10/18/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ka Wing To
- Hong Kong Baptist Hospital Kowloon Tong Hong Kong
| | - Iris Fung‐Kam Lee
- Nethersole Institute of Continuing Holistic HealthSchool of Nursing, Faculty of MedicineThe University of Hong Kong Shatin Hong Kong
| | - Kai Chow Choi
- Nethersole Institute of Continuing Holistic HealthSchool of Nursing, Faculty of MedicineThe University of Hong Kong Shatin Hong Kong
| | - Yannes Tsz Yan Cheung
- Nethersole Institute of Continuing Holistic HealthSchool of Nursing, Faculty of MedicineThe University of Hong Kong Shatin Hong Kong
| | - Doris Sau‐Fung Yu
- Nethersole Institute of Continuing Holistic HealthSchool of Nursing, Faculty of MedicineThe University of Hong Kong Shatin Hong Kong
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24
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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: 17] [Impact Index Per Article: 4.3] [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.
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25
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Boudewijns EA, Claessens D, van Schayck OCP, Keijsers LCEM, Salomé PL, In 't Veen JCCM, Bilo HJG, Gidding-Slok AHM. ABC-tool reinvented: development of a disease-specific 'Assessment of Burden of Chronic Conditions (ABCC)-tool' for multiple chronic conditions. BMC FAMILY PRACTICE 2020; 21:11. [PMID: 31931729 PMCID: PMC6958572 DOI: 10.1186/s12875-019-1075-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/24/2019] [Indexed: 02/03/2023]
Abstract
Background Numerous instruments have been developed to assess patient reported outcomes; most approaches however focus on a single condition. With the increasing prevalence of multimorbidity, this might no longer be appropriate. Moreover, a more comprehensive approach that facilitates shared decision making and stimulates self-management is most likely more valuable for clinical practice than a questionnaire alone. This study aims to transform the Assessment of Burden of Chronic Obstructive Pulmonary Disease (COPD) (ABC)-tool into the Assessment of Burden of Chronic Conditions (ABCC)-tool for COPD, asthma, and diabetes mellitus type 2 (DM2). The tool consists of a scale, a visualisation of the outcomes, and treatment advice. Methods Requirements for the tool were formulated. Questionnaires were developed based on a literature study of existing questionnaires, clinical guidelines, interviews with patients and healthcare providers, and input from an expert group. Cut-off points and treatment advice were determined to display the results and to provide practical recommendations. Results The ABCC-scale consists of a generic questionnaire and disease-specific questionnaires, which can be combined into a single individualized questionnaire for each patient. Results are displayed in one balloon chart, and each domain includes practical recommendations. Conclusions The ABCC-tool is expected to facilitate conversations between a patient and a healthcare provider, and to help formulate treatment plans and care plans with personalised goals. By facilitating an integrated approach, this instrument can be applied in a variety of circumstances and disease combinations.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Danny Claessens
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Lotte C E M Keijsers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | | | - Johannes C C M In 't Veen
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Pulmonology, Erasmus MC, Rotterdam, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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26
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Willard-Grace R, Chirinos C, Wolf J, DeVore D, Huang B, Hessler D, Tsao S, Su G, Thom DH. Lay Health Coaching to Increase Appropriate Inhaler Use in COPD: A Randomized Controlled Trial. Ann Fam Med 2020; 18:5-14. [PMID: 31937527 PMCID: PMC7227462 DOI: 10.1370/afm.2461] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/08/2019] [Accepted: 05/05/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Poor adherence to medications is more prevalent for chronic obstructive pulmonary disease (COPD) than for other chronic conditions and is associated with unfavorable health outcomes. Few interventions have successfully improved adherence for COPD medications; none of these use unlicensed health care personnel. We explored the efficacy of lay health coaches to improve inhaler adherence and technique. METHODS Within a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from urban, public primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive 9 months of health coaching or usual care. Outcome measures included self-reported adherence to inhaled controller medications in the past 7 days and observed technique for all inhalers. We used generalized linear models, controlling for baseline values and clustering by site. RESULTS Baseline adherence and inhaler technique were uniformly poor and did not differ by study arm. At 9 months, health-coached patients reported a greater number of days of adherence compared with usual care patients (6.4 vs 5.5 days; adjusted P = .02) and were more likely to have used their controller inhalers as prescribed for 5 of the last 7 days (90% vs 69%; adjusted P = .008). They were more than 3 times as likely to demonstrate perfect technique for all inhaler devices (24% vs 7%; adjusted P = .01) and mastery of essential steps (40% vs 11%; adjusted P <.001). CONCLUSIONS Health coaching may provide a scalable model that can improve care for people living with COPD.
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Affiliation(s)
- Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Chris Chirinos
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Jessica Wolf
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Denise DeVore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Beatrice Huang
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, California
| | - George Su
- Department of Medicine: Pulmonology, Critical Care, Allergy and Sleep Medicine Program, University of California San Francisco, San Francisco, California
| | - David H Thom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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Kim C, Lehmann CU, Hatch D, Schildcrout JS, France DJ, Chen Y. Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay. ... IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING. IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING 2019; 2019:127-134. [PMID: 32637942 PMCID: PMC7339831 DOI: 10.1109/cic48465.2019.00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
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Affiliation(s)
- Cindy Kim
- Department of Mathematics, Vanderbilt University, Nashville, TN
| | | | - Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Daniel J France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Glenister K, Haines H, Disler R. Benefits of the 'village': a qualitative exploration of the patient experience of COPD in rural Australia. BMJ Open 2019; 9:e030953. [PMID: 31594890 PMCID: PMC6797421 DOI: 10.1136/bmjopen-2019-030953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES This study sought to explore patients' experiences of living with, and adapting to, chronic obstructive pulmonary disease (COPD) in the rural context. Specifically, our research question was 'What are the barriers and facilitators to living with and adapting to COPD in rural Australia?' DESIGN Qualitative, semi-structured interviews. Conversations were recorded, transcribed verbatim and analysed using thematic analysis following the COnsolidated criteria for REporting Qualitative research guidelines. SETTING Patients with COPD, admitted to a subregional hospital in Australia were invited to participate in interviews between October and November 2016. MAIN OUTCOME MEASURES Themes were identified that assisted with understanding of the barriers and facilitators to living with, and adapting to, COPD in the rural context. RESULTS Four groups of themes emerged: internal facilitators (coping strategies; knowledge of when to seek help) and external facilitators (centrality of a known doctor; health team 'going above and beyond' and social supports) and internal/external barriers to COPD self-management (loss of identity, lack of access and clear communication, sociocultural challenges), which were moderated by feelings of inclusion or isolation in the rural community or 'village'. CONCLUSIONS Our findings suggest that community inclusion enhances patients' ability to cope and ultimately self-manage COPD. This is facilitated by living in a supportive 'village' environment, and included a central, known doctor and a healthcare team willing to go 'above and beyond'. Understanding, or supplementing, these social networks within the broader social structure may assist people to manage chronic disease, regardless of rural or metropolitan location.
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Affiliation(s)
- Kristen Glenister
- University of Melbourne Department of Rural Health, Wangaratta, Victoria, Australia
| | - Helen Haines
- University of Melbourne Department of Rural Health, Wangaratta, Victoria, Australia
| | - Rebecca Disler
- University of Melbourne Department of Rural Health, Shepparton, Victoria, Australia
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Goodridge D, Peters J. Palliative care as an emerging role for respiratory health professionals: Findings from a cross-sectional, exploratory Canadian survey. ACTA ACUST UNITED AC 2019; 55:73-80. [PMID: 31595226 PMCID: PMC6762004 DOI: 10.29390/cjrt-2019-010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Respiratory Health Professionals (RHPs) with specialty training in the management of asthma and COPD, often care for patients with advanced respiratory disease, who have less access to palliative care than patients with similar disease burden. The aims of this study were to: (i) explore the current and desired roles of RHPs in terms of palliative care and (ii) examine barriers to discussions with patients about palliative care. Methods An online survey addressing the aims of this study was developed and pilot tested. The survey was distributed nationally using the database of the Lung Association's RESPTREC respiratory educator training program. Descriptive statistics were performed. Results A total of 123 completed surveys were returned, with respiratory therapists comprising the largest group of respondents. The majority indicated that end-of-life care was less than optimal for patients with advanced respiratory illnesses and agreed that palliative care should be a role of RHPs. Patient- and family-related barriers to having end-of-life discussions included: difficulty accepting prognosis, limitations and complications, and lack of capacity. For providers, the most important barriers were: lack of training, uncertainty about prognosis, and lack of time. The health care system barriers of concern were increasing demand for palliative care services and limited accessibility of palliative care for those with advanced respiratory diseases and difficulties in accurate prognostication for these conditions. Discussion Incorporating a more defined role in palliative care was generally seen as a desirable evolution of the RHP role. A number of strategies to mitigate identified barriers to discussions with the patient are described. Better alignment of the services required with the needs of patients with advanced respiratory disease can be addressed in a number of ways. Conclusions As RHP roles continue to evolve, consideration should be given to the ways in which RHPs can contribute to improving the quality of care for patients with advanced respiratory disease. Building collaborations with RHPs, palliative care, and other existing health programs can ensure high quality of care. Creating and taking advantage of learning opportunities to build skills and comfort in using a palliative approach will benefit respiratory patients.
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Affiliation(s)
- Donna Goodridge
- College of Medicine, Repiratory Research Centre, University of Saskatchewan, Saskatoon, SK
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Hosseinzadeh H, Shnaigat M. Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review. Aust J Prim Health 2019; 25:PY18181. [PMID: 31203839 DOI: 10.1071/py18181] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the more disabling diseases and the third cause of mortality worldwide. Self-management is considered an effective strategy for controlling and managing COPD. This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care settings. Social Sciences, Citation Index, MEDLINE, CINAHL, Academic Search Complete and Scopus were searched for randomised controlled trials of COPD self-management in general practice between 2001 and 2018. Ten randomised controlled trials of COPD self-management trials conducted in primary care settings were included in this review. The identified trials have recruited stable patients; a majority having mild to moderate COPD. The trials implemented different types of interventions and measured improvements in knowledge, skills and behaviours of self-management, mental health, self-efficacy and endpoint outcomes such as hospitalisation and quality of life. The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication, physical activities and smoking cessation in some cases; however, the effect of trials on hospitalisation rate, quality of life and healthcare utilisation were not conclusive. There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy, a major driver of self-management behaviours. Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours; however, such improvements are less likely to be sustainable in the absence of self-efficacy. Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system.
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Affiliation(s)
- Hassan Hosseinzadeh
- School of Health & Society, Building 15, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Mahmmoud Shnaigat
- School of Health & Society, Building 15, University of Wollongong, Wollongong, NSW 2522, Australia; and Corresponding author
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Grischott T, Falcato L, Senn O, Puhan MA, Bruggmann P. Chronic obstructive pulmonary disease (COPD) among opioid-dependent patients in agonist treatment. A diagnostic study. Addiction 2019; 114:868-876. [PMID: 30675957 DOI: 10.1111/add.14559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/08/2018] [Accepted: 01/14/2019] [Indexed: 01/14/2023]
Abstract
AIMS To estimate the prevalence of chronic obstructive pulmonary disease (COPD) and related risk factors in people in opioid agonist treatment (OAT), to compare airflow limitation severity and age-specific COPD prevalence rates with those in the general population, and to assess the OAT patients' willingness to adopt life-style changes and to use therapeutic offers for COPD management. DESIGN Cross-sectional study in a random sample of OAT patients. SETTING Out-patient centres for substance addiction medicine in Zurich, Switzerland. PARTICIPANTS A total of 125 participants, recruited from November 2016 to April 2017 through invitation letters followed by phone or personal contact. MEASUREMENTS Standardized questionnaires about drug use, smoking habits and medical history, completed during face-to-face interviews or from medical records. Spirometry without and-depending on the result-with bronchodilation. FINDINGS Almost one-third [30.3%; 95% confidence interval (CI) = 22.6-39.0%] of the 119 participants with valid spirometry tests were diagnosed with COPD. Among males aged 30-59 years, the age-adjusted prevalence of at least moderate airflow limitation (GOLD grade ≥ 2) was 2.4 (95% CI = 1.3-4.4) times as high as in the ever-smoking Swiss population in the same age group. Smoking tobacco (92.0%) and substance inhalation (cannabis = 97.6%, cocaine = 69.6%, heroin = 68.0%) were highly prevalent among all participants. The participants expressed considerable interest in life-style changes and use of therapeutic offers for COPD management, with smoking cessation being least (20.2% of tobacco smokers interested) and pharmacological treatment to alleviate COPD symptoms most popular. CONCLUSIONS In Switzerland, COPD prevalence and multiple risk factors for COPD appear to be high among people in OAT compared with the general population. Individuals in OAT appear to develop COPD at a younger average age compared with the general population and are open to life-style changes and other COPD management approaches.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland
| | - Luis Falcato
- Arud Centre for Addiction Medicine, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Philip Bruggmann
- Institute of Primary Care (IHAMZ), University and University Hospital of Zurich, Zurich, Switzerland.,Arud Centre for Addiction Medicine, Zurich, Switzerland
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Gupta A, Ravaliya V, Mishra D, Dani V, Sodawala C, Shah H, Patel D. Assessment of knowledge, attitude, and behavior about the disease process and physiotherapy management in patients with chronic obstructive pulmonary disease: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:15. [PMID: 30815486 PMCID: PMC6378829 DOI: 10.4103/jehp.jehp_209_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/08/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases; the most common are emphysema and chronic bronchitis. It is considered to be the major cause of morbidity and mortality worldwide and is considered to be one of the leading causes of deaths in India, the main reason being misconception/misinterpretation of the disease and unawareness about the risk factors which hinder early diagnosis and its treatment effectively. Therefore, the present study aimed to assess the knowledge, attitude and behavior about the disease process and physiotherapy management in patients diagnosed with COPD. MATERIALS AND METHODS Ethical clearance was obtained before initiating the study. It was a cross-sectional, qualitative study. In total, 14 patients of COPD were recruited for the study by convenience sampling. The total study duration was 6 months. Two focused groups (n = 14) were conducted with seven COPD patients (diagnosed by chest physician on the basis of pulmonary function testing) in each after obtaining the written informed consent. Focus group contents were video graphed after obtaining the consent and a focus group discussion (FGD) guide comprising of 15 questions was used for the study. Transcripts were prepared from the audio/video recordings and were analyzed qualitatively by narrative analysis. RESULTS The narration transcripted during both the sessions of FGD showed significant negligence about the disease process, its precipitating factors, preventive measures, and physiotherapy management among the patients suffering from COPD in the community. None of the patients were aware even about the term "chronic obstructive pulmonary disease" and only 35.71% of patients were aware of physiotherapy management as a mean of treatment for COPD. CONCLUSIONS The present study concludes that there is a lack of knowledge, incorrect attitudes, and flawed behavioral changes which needs to be corrected among the patients with COPD. These patients require correct, detailed, and broad-based information about their condition and availability of treatment options.
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Affiliation(s)
- Ashish Gupta
- K M Patel Institute of Physiotherapy, H M Patel Centre for Medical Care and Education, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | | | - Daxa Mishra
- K M Patel Institute of Physiotherapy, H M Patel Centre for Medical Care and Education, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | - Vyoma Dani
- K M Patel Institute of Physiotherapy, H M Patel Centre for Medical Care and Education, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
| | | | - Hardi Shah
- Hamilton Grove Healthcare and Rehab Centre, NJ, USA
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Shahahmad BS, Khan AA, Batais MA, Gaumer GL. A survey of physicians' experience and awareness of institutional provisions designed to foster patient engagement in KSA. J Taibah Univ Med Sci 2018; 13:291-297. [PMID: 31435336 PMCID: PMC6694904 DOI: 10.1016/j.jtumed.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Anas A. Khan
- Department of Emergency Medicine, College of Medicine and University Medical City, King Saud University, Riyadh, KSA
- Corresponding address: Department of Emergency Medicine, College of Medicine and University Medical City, King Saud University, Riyadh, KSA.
| | - Mohammed A. Batais
- Department of Family and Community Medicine, College of Medicine and University Medical City, King Saud University, Riyadh, KSA
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Markun S, Rosemann T, Dalla-Lana K, Steurer-Stey C. Care in Chronic Obstructive Lung Disease (CAROL): a randomised trial in general practice. Eur Respir J 2018; 51:13993003.01873-2017. [DOI: 10.1183/13993003.01873-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/31/2018] [Indexed: 11/05/2022]
Abstract
Disease management of chronic obstructive pulmonary disease (COPD) is complex and shortcomings in general practice care for COPD are common. A care bundle is a disease management aid used as a reminder and for steering specific elements of care. Our objectives were to test whether a COPD care bundle delivered to general practitioners (GPs) and practice assistants increases the implementation of key elements of COPD care.The study was a cluster-randomised clinical trial, with 1:1 randomisation of GPs and a 1-year follow-up. The intervention introduced a COPD care bundle and aimed at enhancing collaboration between GPs and practice assistants. The control group continued usual care. The primary outcome measure was the composite score from nine key elements of COPD care measured at the patient level.We enrolled 35 GPs and 216 patients with a median age of 69 years, 59% female, 69% Global Initiative for Chronic Obstructive Lung Disease group A or B. After 1 year, the between-group difference in change of the primary outcome measure was +2.2 (95% CI +1.5– +2.9) in favour of the intervention group. The intervention was associated with significantly higher implementation rates in seven out of nine key elements of care.Disease management using a COPD care bundle increased the implementation of key elements of COPD care in general practice.
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Steurer-Stey C, Dalla Lana K, Braun J, Ter Riet G, Puhan MA. Effects of the "Living well with COPD" intervention in primary care: a comparative study. Eur Respir J 2018; 51:51/1/1701375. [PMID: 29301921 DOI: 10.1183/13993003.01375-2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/28/2017] [Indexed: 12/23/2022]
Abstract
The pivotal objective of chronic obstructive pulmonary disease (COPD) self-management programmes is behaviour change to avoid moderate and severe exacerbations and improve health related quality of life.In a prospectively planned, controlled study, COPD patients who participated in the "Living well with COPD" (LWWCOPD) self-management intervention were compared with usual care patients from the primary care COPD Cohort ICE COLD ERIC, who did not receive self-management intervention (NCT00706602) The primary outcome was behaviour change and disease-specific health related quality of life after 1 year. Secondary end-points included exacerbation rates. We calculated mixed linear, zero-inflated negative binomial and logistic regression models and used propensity scores to counteract confounding.467 patients, 71 from the LWWCOPD and 396 from the usual care cohort, were included. The differences between intervention and control were 0.54 (95% CI 0.13-0.94) on the Chronic Respiratory Questionnaire domain "mastery", 0.55 (95% CI 0.11-0.99) on "fatigue", 0.54 (0.14-0.93) on "emotional function" and 0.64 (95% CI 0.14-1.14) on "dyspnoea". The intervention considerably reduced the risk of moderate and severe exacerbations (incidence rate ratio 0.36, 95% CI 0.25-0.52).Self-management coaching in primary care improves health-related quality of life and lowers exacerbation rates and health care use.
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Affiliation(s)
- Claudia Steurer-Stey
- Institute of Primary Care, University of Zurich, Zurich, Switzerland .,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,mediX Group Practice, Zurich, Switzerland
| | - Kaba Dalla Lana
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,mediX Group Practice, Zurich, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Gerben Ter Riet
- Dept of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Clini E, Castaniere I, Tonelli R. Looking for a chronic care model in COPD patients. Eur Respir J 2018; 51:51/1/1702087. [DOI: 10.1183/13993003.02087-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 11/05/2022]
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Calle Rubio M, López-Campos JL, Soler-Cataluña JJ, Alcázar Navarrete B, Soriano JB, Rodríguez González-Moro JM, Fuentes Ferrer ME, Rodríguez Hermosa JL. Variability in adherence to clinical practice guidelines and recommendations in COPD outpatients: a multi-level, cross-sectional analysis of the EPOCONSUL study. Respir Res 2017; 18:200. [PMID: 29197415 PMCID: PMC5712134 DOI: 10.1186/s12931-017-0685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. METHODS EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics. RESULTS A total of 4508 clinical records of COPD patients from 59 Spanish hospitals were evaluated. High variability was observed among hospitals in terms of medical care. Some of the patient's characteristics (airflow obstruction, degree of dyspnea, exacerbation risk, presence of comorbidities), the hospital factors (size and respiratory nurses available) and treatment at a specialized COPD outpatient clinic were identified as factors associated with a better adherence to recommendations, although this only explains a small proportion of the total variance. CONCLUSION To be treated at a specialized COPD outpatient clinic and some intrinsic patient characteristics were factors associated with a better adherence to guideline recommendations, although these variables were only explaining part of the high variability observed among hospitals in terms of COPD medical care.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain.
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad of Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Joan B Soriano
- Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid, Madrid, Spain
| | | | - Manuel E Fuentes Ferrer
- UGC de Medicina Preventiva, Research Institute of Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Madrid, Spain
| | - Juan Luis Rodríguez Hermosa
- Pulmonary Department, Research Institute of Hospital Clínico San Carlos (IdISSC), Faculty of Medicine, University Complutense of Madrid, C/ Martin Lagos s/n, 28040, Madrid, Spain
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Markun S, Franzen DP, Dalla Lana K, Beyer S, Wieser S, Hess T, Kohler M, Rosemann T, Senn O, Steurer-Stey C. Acute exacerbated COPD: room for improvement in key elements of care. Int J Chron Obstruct Pulmon Dis 2017; 12:2969-2975. [PMID: 29066878 PMCID: PMC5644547 DOI: 10.2147/copd.s145496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitalizations because of acute exacerbated COPD (AECOPD) are a major burden to patients and the health care system. Interventions during acute and post-acute hospital care exist not only to improve short-term outcomes but also to prevent future exacerbations and disease progression. We aimed at measuring the implementation rates of acute and post-acute hospital care interventions for AECOPD. Methods We performed 24 months (January 1, 2012, to December 31, 2013) retrospective medical chart review of consecutive cases hospitalized to one of three public hospitals in the canton of Zurich due to AECOPD. Implementation rates of five acute care and seven post-acute care interventions were assessed. Results Data from 263 hospitalizations (61% male, mean age 68.5 years, 47% active smokers) were analyzed. The median length of stay was 9 days (interquartile range [IQR] 6–12 days). In all, 32% of hospitalizations were caused by individuals with previous hospitalizations because of AECOPD. Implementation rates of four acute care interventions were >75% (lowest was appropriate antibiotic therapy with 56%). Compared to this, implementation rates of five post-acute care interventions were <25% (lowest was patient education and self-management advice with 2%). Conclusion The results of this audit revealed room for improvement mainly in post-acute care interventions for AECOPD.
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Affiliation(s)
| | - Daniel P Franzen
- Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich
| | | | - Swantje Beyer
- Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur
| | | | - Thomas Hess
- Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur
| | - Malcolm Kohler
- Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich
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Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is expected to increase as the population ages. Patients have a high symptom burden, low healthcare quality of life, and unmet needs at the end of life. This review highlights specific palliative care needs of patients with advanced COPD and opportunities to integrate palliative care into standard practice. RECENT FINDINGS There are many barriers to providing integrated palliative care in COPD, including difficulty with prognostication, communication barriers surrounding advance care planning, and lack of access to specialty palliative care. Because of the unique disease trajectory, emphases on early and primary palliative care are being studied in this patient population. SUMMARY Palliative care is appropriate for patients with COPD and should be integrated with disease-specific therapies. The line between life prolonging and palliative care undoubtedly overlaps and maximizing quality of life throughout the continuum of care should be prioritized for patients with this progressive illness.
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Huang B, Willard-Grace R, De Vore D, Wolf J, Chirinos C, Tsao S, Hessler D, Su G, Thom DH. Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial. BMC Pulm Med 2017; 17:90. [PMID: 28599636 PMCID: PMC5466738 DOI: 10.1186/s12890-017-0433-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/31/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) severely hinders quality of life for those affected and is costly to the health care system. Care gaps in areas such as pharmacotherapy, inhaler technique, and knowledge of disease are prevalent, particularly for vulnerable populations served by community clinics. Non-professionally licensed health coaches have been shown to be an effective and cost-efficient solution in bridging care gaps and facilitating self-management for patients with other chronic diseases, but no research to date has explored their efficacy in improving care for people living with COPD. METHOD This is multi-site, single blinded, randomized controlled trial evaluates the efficacy of health coaches to facilitate patient self-management of disease and improve quality of life for patients with moderate to severe COPD. Spirometry, survey, and an exercise capacity test are conducted at baseline and at 9 months. A short survey is administered by phone at 3 and 6 months post-enrollment. The nine month health coaching intervention focuses on enhancing disease understanding and symptom awareness, improving use of inhalers; making personalized plans to increase physical activity, smoking cessation, or otherwise improve disease management; and facilitating care coordination. DISCUSSION The results of this study will provide evidence regarding the efficacy and feasibility of health coaching to improve self-management and quality of life for urban underserved patients with moderate to severe COPD. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02234284 . Registered 12 August 2014.
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Affiliation(s)
- Beatrice Huang
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Rachel Willard-Grace
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Denise De Vore
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Wolf
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chris Chirinos
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie Tsao
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - George Su
- Department of Medicine: Pulmonology, Critical Care, Allergy and Sleep Medicine Program, University of California San Francisco, San Francisco, CA, USA
| | - David H Thom
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
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Shin J, Park HY, Lee J. Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.14475/kjhpc.2017.20.2.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Foley H, Steel A. Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim M, Asche CV, Tillis W, Ren J. Association between availability of care providers and healthcare utilizations among adults with asthma. Curr Med Res Opin 2017; 33:479-487. [PMID: 27882775 DOI: 10.1080/03007995.2016.1264930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited accessibility to providers may delay appropriate control of asthma exacerbations. The objective of our study is to estimate the contributors to the hospital/emergency department (ED) visits among adults with asthma focusing on the availability of healthcare providers. METHODS We conducted a pooled cross-sectional analysis using the 2011-2013 Asthma Call-Back Survey linked with 2012-2016 Area Health Resource Files. We employed multivariable logistic regression with dichotomous outcomes of hospitalization and ED visits. Key covariates were the availability of county-level healthcare provider variables per 100,000 persons such as the number of lung disease specialists (including pulmonary care specialists, and allergy and immunology specialists), the number of hospitals, the number of safety-net facilities including rural health centers (RHCs) and federally qualified health centers (FQHCs), and the number of primary care physicians (PCPs). RESULTS Among 25,621 adults, proportions of hospital visits and ED visits were 3.3% and 13.2%, respectively. An additional RHC reduced by 3% the odds of having an ED visit (odds ratio [OR] = 0.97, p = .004). Patients with cost barriers to seeing a PCP were 60% (OR = 1.60, p = .028) more likely to have a hospital visit than those without. In addition, patients with cost barriers to seeing a specialist were 90% (OR = 1.90, p = .007) and 111% (OR = 2.11, p = .001) more likely to have a hospital visit and ED visit, respectively, than those without. CONCLUSIONS Hospital and ED visits among adults with asthma are partially related to the availability of providers, and more related to financial barriers. Therefore, financial support for the vulnerable asthma population might be a target for policy makers interested in reducing hospitalizations and ED visits.
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Affiliation(s)
- Minchul Kim
- a Center for Outcomes Research/Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
| | - Carl V Asche
- a Center for Outcomes Research/Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
- b Department of Pharmacy Systems, Outcomes and Policy , University of Illinois at Chicago College of Pharmacy , Chicago , IL , USA
| | - William Tillis
- c OSF St. Francis Medical Center , Peoria , IL , USA
- d Department of Internal Medicine, University of Illinois College of Medicine at Peoria , Peoria , IL , USA
| | - Jinma Ren
- a Center for Outcomes Research/Department of Internal Medicine , University of Illinois College of Medicine at Peoria , Peoria , IL , USA
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Calle Rubio M, Alcázar Navarrete B, Soriano JB, Soler-Cataluña JJ, Rodríguez González-Moro JM, Fuentes Ferrer ME, López-Campos JL. Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study. Int J Chron Obstruct Pulmon Dis 2017; 12:417-426. [PMID: 28182155 PMCID: PMC5279956 DOI: 10.2147/copd.s124482] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. METHODOLOGY This is an observational study with prospective recruitment (May 2014-May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. RESULTS A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. CONCLUSION The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing its variability, strengths, and weaknesses. This information has to be accounted for by health managers to define corrective strategies and maximize good clinical practice.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Hospital Clínico San Carlos
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid
- Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid
| | | | - Joan B Soriano
- Research Institute of Hospital University La Princesa (IISP), University Autónoma of Madrid
| | | | | | - Manuel E Fuentes Ferrer
- Department of Medicine, Faculty of Medicine, University Complutense of Madrid
- Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid
- UGC of Preventive Medicine and Research Institute of Hospital Clínico San Carlos, Madrid
| | - José Luis López-Campos
- Pulmonary Department, Hospital University Virgen del Rocio, Institute of Biomedicine of Sevilla (IBiS), Sevilla, Spain
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45
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Amin AN, Ganapathy V, Roughley A, Small M. Confidence in correct inhaler technique and its association with treatment adherence and health status among US patients with chronic obstructive pulmonary disease. Patient Prefer Adherence 2017; 11:1205-1212. [PMID: 28744110 PMCID: PMC5513874 DOI: 10.2147/ppa.s140139] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Improper use of bronchodilators is associated with poor disease control, nonadherence to long-term therapy, and poor clinical outcomes. Our current understanding of factors associated with correct inhaler use and adherence is limited. We measured physician-and patient-reported confidence in device usage and associations with treatment adherence and COPD-related health status. METHODS This was an analysis of a US observational, point-in-time survey of physicians and patients. Physicians who met study eligibility criteria completed surveys for 5 consecutive, eligible patients who were then invited to respond to questionnaires. We assessed patient demographics, type of prescribed inhaler device(s), device training, COPD severity, comorbidities, physician-and patient self-reported confidence in device usage, treatment adherence, and health status. RESULTS Completed questionnaires for 373 patients were provided by 134 physicians. Complete confidence in device usage was observed for 22% and 17% of patients as reported by patients and physicians, respectively. Greater confidence was associated with higher self-reported adherence to inhaler usage. Physicians were more likely than patients to report lower levels of patient confidence in device usage. High physician- and patient-reported confidence were associated with more favorable health status. Predictors of confidence in device usage included fewer comorbidities, no depression, and higher education levels. CONCLUSION Low confidence in inhaler usage was associated with lower adherence and poor COPD-related health status. Choice of inhaler device tailored to patients' ability to use specific devices and ongoing education to support optimal inhaler usage may improve patient confidence and enhance both adherence and health status.
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Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California, Irvine, USA
- Correspondence: Alpesh N Amin, Department of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA, Tel +1 714 456 3785, Email
| | - Vaidyanathan Ganapathy
- Global Health Economics & Outcomes Research, Sunovion Pharmaceuticals Inc, Marlborough, USA
| | - Adam Roughley
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - Mark Small
- Respiratory Research, Adelphi Real World, Bollington, UK
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Abstract
Patients with chronic lung diseases suffer higher symptom burden, lower quality of life, and greater social isolation compared with patients with other diagnoses, such as cancer. These conditions may be alleviated by palliative care, yet palliative care is used less by patients with chronic lung disease compared with patients with cancer. Underuse is due, in part, to poor implementation of primary palliative care and inadequate referral to specialty palliative care. Lack of primary and specialty palliative care in patients with chronic lung disease falls short of the minimum standard of competent health care, and represents a disparity in health care and a social injustice. We invoke the ethical principles of justice and sufficiency to highlight the importance of this issue. We identify five barriers to implementing palliative care in patients with chronic lung disease: uncertainty in prognosis; lack of provider skill to engage in discussions about palliative care; fear of using opioids among patients with chronic lung disease; fear of diminishing hope; and perceived and implicit bias against patients with smoking-related lung diseases. We propose mechanisms for improving implementation of palliative care for patients with chronic lung disease with the goal of enhancing justice in health care.
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'To use or not to use': a qualitative study to evaluate experiences of healthcare providers and patients with the assessment of burden of COPD (ABC) tool. NPJ Prim Care Respir Med 2016; 26:16074. [PMID: 27853139 PMCID: PMC5113148 DOI: 10.1038/npjpcrm.2016.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/08/2022] Open
Abstract
In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of 'motivational interviewing' and 'individualised care-planning'. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers.
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Burchette JE, Campbell GD, Geraci SA. Preventing Hospitalizations From Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Med Sci 2016; 353:31-40. [PMID: 28104101 DOI: 10.1016/j.amjms.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/27/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
Chronic obstructive lung disease is among the leading causes of adult hospital admissions and readmissions in the United States. Preventing acute exacerbations is the primary approach in therapy. Combinations of smoking cessation, pulmonary rehabilitation, vaccinations and inhaled and oral medications may all reduce the overall risk of acute exacerbations. When prevention is unsuccessful, treatment of exacerbations often does not require hospitalization but can be safely executed in the outpatient setting. In the patient who does not require mechanical ventilation or who manifests respiratory acidosis, oxygen supplementation, frequent short-acting inhaled bronchodilators, oral corticosteroids and often antibiotics can abort the decompensation and sometimes return the patient to his or her pre-attack baseline lung function. Several models exist for delivering this care in the ambulatory setting. Follow-up care after an exacerbation has resolved is important, though there are few hard data suggesting which approach is best in this setting.
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Affiliation(s)
- Jessica E Burchette
- Department of Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee.
| | - G Douglas Campbell
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Mississippi School of Medicine, Jackson, Mississippi; G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Müllerová H, Landis SH, Aisanov Z, Davis KJ, Ichinose M, Mannino DM, Maskell J, Menezes AM, van der Molen T, Oh YM, Tabberer M, Han MK. Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey. Int J Chron Obstruct Pulmon Dis 2016; 11:881-90. [PMID: 27217741 PMCID: PMC4853156 DOI: 10.2147/copd.s102280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease. METHODS This was a population-based, cross-sectional survey of 4,343 subjects aged ≥40 years from 12 countries, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. The impact of COPD was measured with COPD Assessment Test, modified Medical Research Council Dyspnea Scale, and hospital admissions and emergency department visits for COPD in the prior year. The 13-item Patient Activation Measure (PAM-13) instrument and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used to measure patient disease engagement and medication adherence, respectively. RESULTS Twenty-eight percent of subjects reported being either disengaged or struggling with their disease (low engagement: PAM-13 levels 1 and 2), and 35% reported poor adherence (MMAS-8 <6). In univariate analyses, lower PAM-13 and MMAS-8 scores were significantly associated with poorer COPD-specific health status, greater breathlessness and lower BMI (PAM-13 only), less satisfaction with their doctor's management of COPD, and more emergency department visits. In multivariate regression models, poor satisfaction with their doctor's management of COPD was significantly associated with both low PAM-13 and MMAS-8 scores; low PAM-13 scores were additionally independently associated with higher COPD Assessment Test and modified Medical Research Council scores and low BMI (underweight). CONCLUSION Poor patient engagement and medication adherence are frequent and associated with worse COPD-specific health status, higher health care utilization, and lower satisfaction with health care providers. More research will be needed to better understand what factors can be modified to improve medication adherence and patient engagement.
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Affiliation(s)
| | | | | | | | | | - David M Mannino
- University of Kentucky College of Public Health, Lexington, KY, USA
| | | | | | - Thys van der Molen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Yeon-Mok Oh
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
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