Clinical Outcome of a Cross-Sectorial Lung Team Treating Patients with COPD at High Risk of Exacerbation: A Randomized Controlled Trial

Experiences of patients with advanced COPD affiliated to a cross-sectorial outgoing lung team: A qualitative study

AIM

To explore experiences of patients affiliated to a cross-sectorial outgoing lung team.

BACKGROUND

The outgoing lung team consisted of respiratory nurses from the hospital and community nurses. The lung team offered 24/7 help to patients with advanced chronic obstructive pulmonary disease (COPD) through visits and/or treatment in the patients' home. Affiliation to the lung team reduced both hospitalizations and length of hospital stay due to acute exacerbation of COPD. However, based on questionnaires on health-related quality of life, no significant differences were found between patients affiliated to the lung team and patients receiving usual care.

DESIGN

A qualitative interview study.

METHODS

In total, 16 patients, aged 61-88 years were interviewed between February 2019 and July 2021. They had been affiliated to the outgoing lung team for 1-3 years. Semi-structured interviews were conducted in the patients' home and audio-recorded after informed consent was obtained. The interviews were transcribed verbatim and analysed, inspired by systematic text condensation by Malterud.

FINDINGS

Four themes emerged from the analysis: (1) feeling safe, (2) improvements in living with COPD, (3) avoiding hospitalization and (4) satisfied with staying at home.

CONCLUSION

Affiliation to the cross-sectorial outgoing lung team gave the patients peace of mind and improved their ability to live with advanced COPD. The patients preferred contacting the lung team because they could stay at home and receive treatment, and thus avoid hospitalization.

IMPACT

The findings from this study support that municipalities should consider implementing an outgoing lung team, as it has the potential to bring several benefits, including improving patient self-management.

REPORTING METHOD

The manuscript adhered to Consolidated criteria for reporting qualitative research (COREQ) guideline.

PATIENT OR PUBLIC CONTRIBUTION

Patients were interviewed. Additionally, no patient or public contributed to the design or conduction of the study, analysis, or interpretation of the data.

Effect of telemonitoring on readmissions for acute exacerbation of chronic obstructive pulmonary disease: A randomized clinical trial

INTRODUCTION

Acute exacerbations of chronic obstructive pulmonary disease are associated with high morbidity and mortality. Telemonitoring may reduce the frequency of hospitalization. The aim of this study was to investigate the effect of telemonitoring on hospitalization rates for acute exacerbations of chronic obstructive pulmonary disease.

METHODS

Patients were recruited during hospitalization and equally randomized to telemonitoring or usual care. Telemonitoring participants recorded symptoms and monitored oxygen saturation, heart rate, peak expiratory flow, and body weight. Alerts were generated if readings breached thresholds. Acute exacerbations of chronic obstructive pulmonary disease hospitalizations during the 6 months intervention were compared using logistic regression, and time to first hospitalization was assessed using Cox proportional hazard modeling. The incidence rates for acute exacerbations of chronic obstructive pulmonary disease hospitalization were compared using a negative binomial regression model with between-group comparisons expressed as incidence rate ratios. The telemonitoring group was used as reference.

RESULTS

A total of 222 patients were randomized. 37/112 (33%) in the control group and 31/110 (28%) in the telemonitoring group experienced acute exacerbations of chronic obstructive pulmonary disease hospitalization during the intervention period, odds ratio of 1.26, confidence interval 0.71-2.23, p = 0.4. No difference was seen in time to first hospitalization, hazard ratio 1.23, CI 0.77-1.99, p = 0.4. The number of hospitalizations in the intervention period was 66 in the control group and 42 in the telemonitoring group, with incidence rate ratio 1.42, confidence interval 1.04-1.95, p = 0.03. Adjustment for dyspnea score, smoking, and cohabitation status did not change the results, incidence rate ratio 1.44, confidence interval 1.05-1.99, p = 0.02.

DISCUSSION

Patients who received telemonitoring experienced significantly fewer acute exacerbations of chronic obstructive pulmonary disease hospitalizations, although the overall risk of having at least one hospitalization and the time to first hospitalization was similar between the two groups.

Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards

INTRODUCTION

It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge.

AIM

To explore the process of preparing discharge for patients with COPD in a hospital setting.

METHOD

Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical.

RESULTS

We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike.

CONCLUSION

This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.

Does affiliation to a cross-sectorial lung team impact well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with COPD? A randomised controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing limitations in daily life. A cross-sectorial lung team was established for COPD patients at risk of hospitalisation due to exacerbation of COPD.

AIMS

To investigate the impact of affiliation to a cross-sectorial lung team on well-being, health-related quality of life, symptoms of anxiety and depression and patient involvement in patients with severe COPD.

METHODS

A randomised controlled trial was conducted from September 2017 to March 2020. In total, 109 patients were included for analysis in the study: 53 patients were affiliated to a cross-sectorial lung team and 56 patients received usual care. The patients were included for 1 year. Data were collected at baseline and at follow-up after 1 year. Data were collected using COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), EuroQol 5-Dimensions (EQ-5D) and Patient Assessment of Chronic Illness Care (PACIC).

RESULTS

The questionnaire response rate was between 84% and 96%. No statistically significant differences were detected between patients affiliated to the cross-sectorial lung team and patients receiving usual care, in either patient's well-being, health-related quality of life, symptoms of anxiety and depression, or patient involvement. However, CAT-total score decreased with -0.21(95%CI: -1.63; 1.20) for patients affiliated to the cross-sectorial lung team and increased with 1.44(95%CI; -0.11; 3.00) for patients receiving usual care.

CONCLUSION

Affiliation to the cross-sectorial lung team seems safe as it did not deteriorate the patients' well-being, symptoms of anxiety and depression, health-related quality of life or patient involvement. Further research is needed and interviewing patients to obtain more knowledge on their experiences might be preferable.