Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland?

Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional's Perspective - A Mixed Method Study

Purpose

To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it.

Methods

Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results.

Results

A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention's overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician's resources and difficulties in adaptability.

Conclusion

While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.

Supporting Behavior Change After AECOPD - Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence - including but not limited to patients' perspective - and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.

Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care

Background

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems.

Methods

Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts.

Results

The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD.

Conclusion

COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.

[Effects of Supported Aftercare in the Post-Rehabilitation Phase in COPD Patients: A Controlled Study]

BACKGROUND

 C: hronic O: bstructive P: ulmonary D: isease (COPD) is a chronic degenerative disease characterized by an irreversible obstruction of the respiratory system. Medical rehabilitation is of central importance in disease management. Physical training is one of the most important non-drug therapy modules. The effectiveness of inpatient pneumological rehabilitation is considered proven, but the effects are not sustainable.

AIM OF THE STUDY

 Increasing the sustainability of rehabilitation success in patients with COPD through supported aftercare.

METHOD

 Evaluation of the effectiveness of the New Credo in a single-center, controlled longitudinal study with three measurement times (start of rehabilitation, end of rehabilitation, 12-month follow-up). Rehabilitation patients with confirmed COPD were included. The control group (CG) received the guideline-compliant standard care, the intervention group (IG) underwent rehabilitation and follow-up care in accordance with the New Credo. The New Credo is a concept in which aftercare is taken into account at the start of rehabilitation and which emphasizes the personal responsibility and own initiative of the rehabilitation patients. Supporting tools are used for training clinic employees, including a "to do list", checklists for doctors, information for follow-up institutions. A group session is held for the rehabilitation patients assigned to aftercare; they keep different diaries, which they send the rehabilitation clinic at different times after completing rehabilitation. The clinic provides patients feedback that is intended to support them in maintaining physical activity. The primary outcome measure was participation (I: ndex zur M: essung von E: inschränkungen der T: eilhabe, IMET score) in an intra- and intergroup comparison at three measurement times. Secondary outcomes were: C: OPD A: ssessment T: est (CAT), various P: atient R: eported O: utcome M: easures (PROMs) and the extent of physical activity.

RESULTS

 Complete data on 149 IG and 135 CG members were used (complete case analysis). The participants were on average 64 years old, 57 % (IG) and 67 % (KG) were male. Most of the respondents had COPD grade II-III. Twelve months after rehabilitation, the IG showed the same value for primary outcome participation as at the beginning of rehabilitation (M = 30.8; SD = 21.8), the control group showed worse results (M = 41.3; SD = 24.7). The same findings (stability in the IG, deterioration in the CG) was also seen in the secondary outcomes. In the time after rehabilitation, the IG showed in secondary outcomes less deterioration than the CG, but the differences were not significant. With regard to the increase in physical activity, the IG reported significantly more often that they were able to achieve their subjective rehabilitation goals (69 % vs. 34 %, p < 0.01). In addition, they increased the amount of physical activity in the period after rehabilitation to a greater extent than the CG (p = 0.064). They participated in sports at a sports club more often (15 % vs. 5 %, p < 0.01) and did endurance sports significantly more frequently during the follow-up period (46 % vs. 21 %, p < 0.01) CONCLUSION:  Through the intervention with the New Credo, a lasting effect (effect size ES = .40) was expected for the primary outcome participation in the IG as compared to the CG. This assumption was not confirmed: there was neither a time nor a group effect. However, against the background of the particular importance of physical activity in the course of COPD, integration of physical activity permanently into everyday life by the IG can be looked upon as a sort of success of the New Credo.