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Bove DG, Christensen PE, Gjersøe P, Lavesen M. Patients' experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark. BMJ Open 2022; 12:e060490. [PMID: 35613764 PMCID: PMC9174770 DOI: 10.1136/bmjopen-2021-060490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We aimed to investigate the experiences of Danish patients treated at home for an acute illness instead of being hospitalised. DESIGN This study had a qualitative design inspired by the methodology of interpretive description. Data were collected through semistructured interviews. SETTING Home treatment was conducted by a team of nurses (n=10-15) supported by physiotherapists and physicians, all affiliated with an emergency department, located in the capital region of Denmark. Interviews were conducted between August 2020 and April 2021. PARTICIPANTS Twenty-one patients, aged 34-94 years, narrated their experiences of being treated at home for an acute illness. RESULTS The overarching theme in our analyses was that 'being the centre of the nurses' attention provided safety, patient involvement and quality of life during home treatment'. The following six themes emerged from analyses: (1) exclusive attention facilitates involvement and activity; (2) hospitals are for the sick; (3) maintaining a meaningful everyday life; (4) the hospital exudes productivity and busyness; (5) family relations and roles are maintained; (6) and concerns of deterioration. CONCLUSIONS From a patient's perspective, home treatment made sense and was perceived as a quality improvement. Being the centre of nurses' attention induced a sense of safety, involvement and enhanced quality of life among patients during the treatment course for an acute illness.
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Affiliation(s)
- Dorthe Gaby Bove
- Department of Clinical Research, Nordsjællands Hospital, Hillerod, Denmark
- Centre for Nursing, University College Absalon, Campus Roskilde, Roskilde, Denmark
| | | | - Peter Gjersøe
- Department of Emergency Medicine, Nordsjællands Hospital, Hillerod, Denmark
| | - Marie Lavesen
- Department of Emergency Medicine, Nordsjællands Hospital, Hillerod, Denmark
- Helsingør Rehabilitation and Training Center, Helsingør Municipality, Helsingør, Denmark
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Bove DG, Lavesen M, Lindegaard B. Characteristics and health related quality of life in a population with advanced chronic obstructive pulmonary disease, a cross-sectional study. BMC Palliat Care 2020; 19:84. [PMID: 32552723 PMCID: PMC7301437 DOI: 10.1186/s12904-020-00593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/15/2020] [Indexed: 04/09/2023] Open
Abstract
Background It is important to understand the total burden of COPD and thereby be able to identify patients who need more intensive palliative care to avoid deteriorated quality of life. The aim of this study was to describe the psychosocial and demographic characteristics of a population with advanced COPD in a stable phase of the disease. Methods This study was cross-sectional based on a prospective observational cohort. The following questionnaires were administered: Chronic Respiratory Disease Questionnaire (CRQ), The COPD Assessment Test (CAT), The Hospital and Anxiety and Depression Scale (HADS), The Medical Research Council dyspnoea scale (MRC), and self-rate general health. Results We included 242 patients with advanced COPD from a Danish pulmonary outpatient clinic. Their mean FEV1 was 38% (±12.7) and 19% were treated with long term oxygen. The mean CRQ domain score was CRQ-dyspnea 4.21 (±1.4), CRQ-Mastery 4.88 (±1.3), CRQ-Emotional 4.81 (±1.2), CRQ-Fatigue 3.93 (±1.3). The mean CAT-score was 18.4 (± 6.7), and 44% had a CAT score > 20. The mean score on the subscale for anxiety (HADS-A) and depression (HADS-D) was 5.07 (±3.9) and 5.77 (±3.9), respectively. Thirty percent self-rated their health as bad or very bad and 19.8% were current smokers. Conclusions This study describes the characteristics of a population with advanced COPD in a stable phase of their disease. Our results illustrate how the population although treated in an outpatient structure already focusing on palliative needs, still live with unmet palliative needs and impaired quality of life.
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Affiliation(s)
- D G Bove
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark. .,Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - M Lavesen
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark.,Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - B Lindegaard
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
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Hansen H, Bieler T, Beyer N, Kallemose T, Wilcke JT, Østergaard LM, Frost Andeassen H, Martinez G, Lavesen M, Frølich A, Godtfredsen NS. Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial. Thorax 2020; 75:413-421. [PMID: 32229541 PMCID: PMC7231436 DOI: 10.1136/thoraxjnl-2019-214246] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE Pulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR). OBJECTIVE To investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 <50% eligible for routine hospital-based, outpatient PR. METHODS In this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks' follow-up from baseline. The primary analysis was based on the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS The primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: -6.6 to 24.9)) or at 22 weeks' follow-up (-5.3 metres (95% CI: -28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test p<0.01). CONCLUSION PTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design. Trial registration number ClinicalTrials.gov (NCT02667171), 28 January 2016.
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Affiliation(s)
- Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thomas Kallemose
- Clinical Research Center, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jon Torgny Wilcke
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
| | | | | | - Gerd Martinez
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Marie Lavesen
- Department of Respiratory Medicine and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Nina Skavlan Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
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Abstract
Patients with chronic obstructive pulmonary disease (COPD) often live with unmet palliative needs and low quality of life, although several guidelines recommend that those with COPD should be offered early and integrated palliative care. However, none of the guidelines describe how these recommendations can be operationalised and the current literature offers little information about experiences with developing and implementing new palliative care services. This article offers insight into the experience of developing and implementing a new palliative outpatient structure for patients with severe COPD. All patients are assigned to a nurse who has overall responsibility for establishing and maintaining an individualised relationship with the patient and identifying their needs for care and treatment. Routine outpatient visits are replaced by ad hoc consultations, and patients are seen by pulmonary specialists only when there is a need for medical assessment and treatment or a planned advanced care planning dialogue. The new service was succesfully implemented; however, the changes required good multidisciplinary collaboration, dedicated health professionals and managerial support. This paper highlights the need for further studies to investigate the effectiveness of new palliative care interventions for patients with COPD.
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Affiliation(s)
- Marie Lavesen
- Registered Nurse, Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
| | - Kristoffer Bastrup-Madsen Marsa
- Consultant, Department of Palliative Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Dorthe Gaby Bove
- Postdoctoral Researcher; Registered Nurse, Emergency Department, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
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Bove DG, Jellington MO, Lavesen M, Marså K, Herling SF. Assigned nurses and a professional relationship: a qualitative study of COPD patients' perspective on a new palliative outpatient structure named CAPTAIN. BMC Palliat Care 2019; 18:24. [PMID: 30825878 PMCID: PMC6397743 DOI: 10.1186/s12904-019-0410-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known of how to organize non-malign palliative care, and existing knowledge show that patients with COPD live with unmet palliative needs and low quality of life. With the intent to improve palliative care for patients with COPD, we changed the structure of our outpatient clinic from routine visits by a pulmonary specialist to a structure where each patient was assigned a nurse, offered annual advance care planning dialogues, and ad hoc pulmonary specialist visits. The aim of this study was to explore COPD patients' experiences with a new and altered palliative organization. METHODS The design was interpretive description as described by Thorne. We conducted ten semi-structured interviews with patients with severe COPD from January 2017 to December 2017. RESULTS Patients described how the professional relationship and the availability of their nurse was considered as the most important and positive change. It made the patients feel safe, in control, and subsequently influenced their ability to self-manage their life and prevent being hospitalized. The patients did not emphasize the advanced care planning dialogues as something special or troublesome. CONCLUSION We showed that it is relevant and meaningful to establish a structure that supports professional relationships between patient, nurse and physician based on patients needs. The new way of structuring the outpatient care was highly appreciated by COPD patients and made them feel safe which brought confidence in self-management abilities.
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Affiliation(s)
- D. G. Bove
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - M. O. Jellington
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - M. Lavesen
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - K. Marså
- Department of Palliative Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - S. F. Herling
- Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Section 2091, Inge Lehmanns Vej 7, 2100 Copenhagen Ø, Denmark
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Godtfredsen N, Sørensen TB, Lavesen M, Pors B, Dalsgaard LS, Dollerup J, Grann O. Effects of community-based pulmonary rehabilitation in 33 municipalities in Denmark - results from the KOALA project. Int J Chron Obstruct Pulmon Dis 2018; 14:93-100. [PMID: 30613139 PMCID: PMC6306068 DOI: 10.2147/copd.s190423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The positive impact of pulmonary rehabilitation (PR) in patients with COPD is well documented. However, little is known regarding the effect of this treatment in community-based settings. Since 2007, all Danish municipalities have been offering PR to patients with moderate to severe COPD, whereas patients with very severe disease or those suffering from many comorbidities were referred to outpatient hospital-based PR. Objective To analyze the effect of a standardized PR program conducted in a community-based setting on exercise capacity and health-related quality of life (HRQoL). Methods This is a real-life study including data from patients attending PR at one of the 33 healthcare centers in Denmark during the period 2011–2012. For the purpose of registration and for quality assurance, the KOALA database was established and this web-based registration instrument was offered free of charge to every municipality. Measures included sociodemographic and health-related variables and outcomes were exercise capacity and HRQoL assessed by 6-minute walking distance (6MWD) and the 15D questionnaire, respectively, at the beginning (baseline) and after completion of PR. Relative improvements in 6MWD and 15D were analyzed with multivariable linear models in patients who attended >50% of the sessions. Results A total of 581 patients completed the PR (72% of those included). We found statistically significant and clinically meaningful differences between baseline and end of rehabilitation values for both main outcomes with a mean change in 6MWD of 45 m, and the magnitude of improvement corresponds to other findings. Furthermore, relative improvements in 6MWD and 15D were correlated, as was the relative change in 15D and baseline Medical Research Council scores. Conclusion Standardized, multidisciplinary PR conducted in a community-based setting showed good adherence to the program and produced effects on exercise capacity and HRQoL that were clinically meaningful and comparable in size to hospital-based PR.
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Affiliation(s)
- Nina Godtfredsen
- Department of Respiratory Medicine, Amager and Hvidovre University Hospital, Hvidovre, Denmark, .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,
| | | | - Marie Lavesen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | | | | | | | - Ove Grann
- Municipality of Aalborg, Aalborg, Denmark
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Bove DG, Lavesen M, Jellington MO, Marsaa KBM, Herling SF. First year experiences with a palliative out-patients structure for patients with COPD: a qualitative study of health professionals' expectations and experiences. BMC Palliat Care 2018; 17:113. [PMID: 30296932 PMCID: PMC6176513 DOI: 10.1186/s12904-018-0369-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background To improve the care of patients with advanced COPD and be able to address their palliative needs a new outpatient organization (CAPTAIN) was developed and implemented. CAPTAIN was inspired by best practice and existing guidelines and changed the traditional organization of an outpatient structure including the roles of nurses and doctors. Only sparse knowledge exists of the health professionals’ expectations and experiences to organizational changes in an outpatient setting. This insight is necessary as health professionals are key stakeholders in implementing new structures and successfully transforming knowledge into practice. The aim of this study was to explore the health professionals’ expectations and experiences of a new palliative out-patients structure for patients with advanced COPD. Methods The design was interpretive description as described by Thorne. Focus groups and individual interviews were conducted with pulmonary nurses, pulmonary doctors and municipality nurses from 2014 to 2016. Results The overall theme was dualism. Both nurses and doctors were pending between aspiration and concern in their expectations to the new structure, meanwhile their actual experiences were pending between perceived gain and improvements versus consequences with the new structure. Nurses’ and doctors’ existing practice was altered and the new structure required new ways for them to cooperate and ways in which skills from each profession were most efficiently utilized. Conclusion Nurses and doctors considered the new structure as a quality boost and it fulfilled their hope of improving the quality of care offered to patients with advanced COPD, however with increased work-related stress as a derived consequence.
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Affiliation(s)
- Dorthe Gaby Bove
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark. .,Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - Marie Lavesen
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Maria Omel Jellington
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Kristoffer Bastrup-Madsen Marsaa
- Department of Palliative Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Suzanne Forsyth Herling
- Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Section 2091, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark
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Ryrsø CK, Godtfredsen NS, Kofod LM, Lavesen M, Mogensen L, Tobberup R, Farver-Vestergaard I, Callesen HE, Tendal B, Lange P, Iepsen UW. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med 2018; 18:154. [PMID: 30219047 PMCID: PMC6139159 DOI: 10.1186/s12890-018-0718-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary rehabilitation (PR), delivered as a supervised multidisciplinary program including exercise training, is one of the cornerstones in the chronic obstructive pulmonary disease (COPD) management. We performed a systematic review and meta-analysis to assess the effect on mortality of a supervised early PR program, initiated during or within 4 weeks after hospitalization with an acute exacerbation of COPD compared with usual post-exacerbation care or no PR program. Secondary outcomes were days in hospital, COPD related readmissions, health-related quality of life (HRQoL), exercise capacity (walking distance), activities of daily living (ADL), fall risk and drop-out rate. Methods We identified randomized trials through a systematic search using MEDLINE, EMBASE and Cocharne Library and other sources through October 2017. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using the Cochrane Risk of Bias tool. Results We included 13 randomized trials (801 participants). Our meta-analyses showed a clinically relevant reduction in mortality after early PR (4 trials, 319 patients; RR = 0.58 (95% CI: [0.35 to 0.98])) and at the longest follow-up (3 trials, 127 patients; RR = 0.55 (95% CI: [0.12 to 2.57])). Early PR reduced number of days in hospital by 4.27 days (1 trial, 180 patients; 95% CI: [− 6.85 to − 1.69]) and hospital readmissions (6 trials, 319 patients; RR = 0.47 (95% CI: [0.29 to 0.75])). Moreover, early PR improved HRQoL and walking distance, and did not affect drop-out rate. Several of the trials had unclear risk of bias in regard to the randomization and blinding, for some outcome there was also a lack of power. Conclusion Moderate quality of evidence showed reductions in mortality, number of days in hospital and number of readmissions after early PR in patients hospitalized with a COPD exacerbation. Long-term effects on mortality were not statistically significant, but improvements in HRQoL and exercise capacity appeared to be maintained for at least 12 months. Therefore, we recommend early supervised PR to patients with COPD-related exacerbations. PR should be initiated during hospital admission or within 4 weeks after hospital discharge. Electronic supplementary material The online version of this article (10.1186/s12890-018-0718-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camilla Koch Ryrsø
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Danish Health Authority, Copenhagen, Denmark.
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linette Marie Kofod
- Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Marie Lavesen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
| | - Line Mogensen
- The Department of the Elderly and Disabled, Odense Municipality, Odense, Denmark
| | - Randi Tobberup
- Department of Gastroenterology, Center for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark
| | - Ingeborg Farver-Vestergaard
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | | | - Peter Lange
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Medical Department O, Respiratory Section, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ulrik Winning Iepsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Lavesen M, Ladelund S, Frederiksen AJ, Lindhardt BØ, Overgaard D. Nurse-initiated telephone follow-up on patients with chronic obstructive pulmonary disease improves patient empowerment, but cannot prevent readmissions. Dan Med J 2016; 63:A5276. [PMID: 27697128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Readmissions reduce quality of life and increase mortality. Furthermore, disease severity and shortened length of stay make it difficult to support disease management during admission. The aim of this study was to explore whether telephone follow-up after discharge may reduce readmission rates, lower mortality and improve disease management in patients with chronic obstructive pulmonary disease (COPD). METHODS This was a randomised controlled trial (n = 224) with nurse-initiated telephone intervention after discharge. On day 30, questionnaires about health status and perceptions of disease management were completed. Readmission and death were recorded on days 30 and 84. RESULTS There was no significant difference in readmission rates, but significant differences in patients' assessment of own perception of managing dyspnoea, lung symptoms, ability to react to signs of exacerbation and communicate with health professionals. There was a trend towards a higher mortality in the control group, but it was not statistically significant. CONCLUSIONS Nurse-initiated telephone follow-up does not reduce readmission rates, but does empower patients with COPD. FUNDING The project was funded in part by the Capital Region of Denmark as part of the implementation of The National Plan for Elderly Medical Patients. TRIAL REGISTRATION The Danish Data Protection Agency approved the project (j. no.NOH-2015-035) and approval was obtained from The Regional Ethics Committee (notification number 27518).
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Ringbaek TJ, Lavesen M, Lange P. Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD. Eur Clin Respir J 2016; 3:31016. [PMID: 27225598 PMCID: PMC4880620 DOI: 10.3402/ecrj.v3.31016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/09/2016] [Accepted: 04/18/2016] [Indexed: 12/01/2022] Open
Abstract
Background A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). Objective To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. Methods A total of 115 patients participated in a 7- to 10-week outpatient PR programme in groups of 10–12 individuals. Half of the groups were assigned to PR plus a tablet (tablet group) and the other groups were assigned to PR only (controls). Primary effect parameters were endurance shuttle walk time (ESWT) and disease-specific health status (COPD Assessment Test=CAT). Results The change in ESWT was significantly better in the control group (mean 167 sec) compared with the tablet group (mean 51 sec) (p<0.01), whereas the change in CAT score did not differ significantly between the two groups (−0.6 vs. −2.3) (p=0.17). Conclusions Compared with usual PR, no significant improvements were seen in the group equipped with the tablet after 7–10 weeks of rehabilitation. Future studies should focus on long-term effects.
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Affiliation(s)
| | - Marie Lavesen
- Respiratory Department, Nordsjællands Hospital, Hilleroed, Denmark
| | - Peter Lange
- Respiratory Department, Hvidovre Hospital, Copenhagen, Denmark
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Godtfredsen NS, Grann O, Larsen HB, Sørensen TB, Lavesen M, Pors B, Dalsgaard LS, Kristiansen LC, Andersen KK, Dollerup J. Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health-care centres - the KOALA project. Clin Respir J 2011; 6:186-92. [PMID: 22081963 DOI: 10.1111/j.1752-699x.2011.00272.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implementation of pulmonary rehabilitation in primary health care in Denmark is a new challenge in the management of patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To assess the feasibility of introducing a nationwide web-based tool for data recording and quality assurance in the rehabilitation programmes and to evaluate whether patients are referred correctly according to Danish guidelines for community based COPD rehabilitation. METHODS Participation in the KOALA project has been offered to the municipalities since October 2007. As of October 2010, 62 health-care centres have been invited to participate. We present summary statistics and correlation analyses of the 1699 patients who have been enrolled so far. RESULTS Thirty-three municipalities are currently engaged in the KOALA project. Descriptive analyses reveal that 33% of the patients do not meet the criteria for pulmonary rehabilitation in terms of dyspnoea upon exertion at the baseline visit. Furthermore, information on severity of COPD is missing for 18% of the attendants. The majority of the referred patients have moderate COPD, which is in accordance with the intentions of rehabilitation in the community. Statistical analyses show that COPD-level and grade of dyspnoea are positively correlated and expose significant correlations between both COPD-level and dyspnoea and 6 minutes walking distance (6MWD), incremental shuttle walk distance (ISWT) and quality of life. CONCLUSIONS We conclude that the municipalities in general are interested in the KOALA project as a mean of data recording and sharing and as a quality instrument. Summary statistics show that there is room for improvement in referral and baseline assessments of patients suitable for pulmonary rehabilitation in a community setting.
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