Efecto de una actividad grupal educativa en la calidad de vida de la persona con EPOC

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC), es un importante problema de salud pública que repercute sobre la calidad de vida. Se requieren intervenciones que reduzcan su impacto. Objetivo: Determinar el efecto de una actividad educativa grupal sobre la calidad de vida de personas con EPOC, que asisten a una institución de cuarto nivel durante septiembre-2017 y junio-2018, en Bogotá, Colombia. Métodos: Diseño cuasi-experimental. La variable independiente fue la actividad educativa grupal y la variable dependiente la calidad de vida, medida con el Cuestionario Respiratorio de Saint George (SGRQ). Los pacientes se aleatorizaron con una tabla generada por computador. El grupo control (n=30) recibió la intervención usual y el grupo experimental (n=30) una actividad educativa grupal diseñada bajo recomendaciones internacionales, impartida por el personal de enfermería. Se excluyeron pacientes con asistencia a actividades grupales durante los últimos dos meses. Resultados: La media de la calidad de vida pos-intervención fue 41% y 32% para el grupo control y experimental, respectivamente, se redujeron dos puntos con respecto a la medición inicial. La dimensión de actividad fue la más comprometida. No se encontraron diferencias estadísticamente significativas en el análisis intragrupal ni intergrupal. Discusión: La leve mejoría pos-intervención en las dimensiones de actividad e impacto, así como las variables sociodemográficas son congruentes con otros estudios. Los resultados pueden guardar relación con la cantidad de actividades desarrolladas. Conclusiones: La actividad grupal no genera mejoría estadísticamente significativa en la calidad de vida de las personas con EPOC. Se identificó una mejoría clínica en las dimensiones de actividad e impacto, así como en la puntuación global.

Impact of pharmaceutical care on health outcomes in patients with COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD.

OBJECTIVE

The aim of the present study was to evaluate the impact of pharmaceutical care intervention, with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD.

SETTING

Outpatient COPD Clinic at the Royal Medical Services Hospital.

METHOD

In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patients were followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life, medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS(®) software version 17 for statistical analysis. A P value of <0.05 was considered statistically significant.

MAIN OUTCOME MEASURE

The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures.

RESULTS

A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P < 0.001), medication adherence (P < 0.05), medication beliefs (P < 0.01) and significant reduction in hospital admission rates (P < 0.05) in intervention patients when compared with control group patients at the end of the study.

CONCLUSION

The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD.

[Effectiveness of the correct use of inhalation devices in patients with COPD: randomized clinical trial]

BACKGROUND AND OBJECTIVE

We aimed yo assess whether an educational intervention on the use of inhalational devices improve the functional status of patients with COPD.

PATIENTS AND METHOD

Randomized controlled trial with parallel design and simple blind trial performed in a clinic with 94 patients diagnosed with COPD and who used inhaled devices. Participants were randomized into 2 groups: the intervention group held a training session on the use of inhalers at baseline and one month and strengthening the control group with routine monitoring. The main outcome measure was the change in the synthetic index BODE (Body-Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity).

RESULTS

Patients in the intervention group (n=48) experienced an improvement in the sensation of breathlessness decreasing by 0.85 points (95% CI -1.14 to -0.56) on the MMRC dyspnea scale, while the control group (n=46) did not show any significant change p<0.0001. On the walking test the intervention group walked 6.19 meters (95% CI -4.02 to 16.40) while the control group walked 20.55 meters lower (95% CI -37.80 to -3.28), significant differences with p=0.009. The BODE index decreased (improved) -0.82 points in the intervention group (95% CI -1.16 to -0.46) and increased (worsened) 0.20 in control group (95% CI -0.16 to 0.56) p<0.0001.

CONCLUSIONS

Patients with COPD who receive specific training on inhaler use as compared with those with regular monitoring experience improvement in their functional state.