Comparing Self-management Programs with and without Peer Support Among Patients with Chronic Obstructive Pulmonary Disease

RATIONALE

Self-management support (SMS) is an essential component of care for patients who have chronic obstructive pulmonary disease (COPD), but there is little evidence on how to provide SMS most effectively to these patients. Peer support (i.e. support provided by a person with a similar medical condition) has been successfully used to promote self-management among patients with various chronic conditions, yet no randomized studies have focused on testing its effects for patients with COPD.

OBJECTIVES

To assess whether adding peer support to healthcare professional support to help patients with COPD self-management results in better health-related quality of life (HRQOL) and less acute care use.

METHODS

A 2-arm randomized controlled trial (RCT) was performed at one academic and one community hospital, and their affiliate clinics. Study population included patients aged ≥40 years who had been diagnosed with COPD by a physician and were currently receiving daily treatment for it. Two SMS strategies were compared over six-months. One strategy relied on the healthcare professional (HCP) for COPD self-management (HCP Support); the other used a dual approach involving both healthcare professionals and peer supporters (HCP Plus Peer Support). The primary outcome was change in HRQoL measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months (range 0-100, lower is better; 4-point meaningful difference). Secondary outcomes included the COPD-related and all-cause hospitalizations and ED visits. Analysis was conducted under intention to treat.

RESULTS

The number of enrolled participants was 292. Mean age was 67.7 (SD 9.4) years; 70.9% white and 61.3% female . SGRQ scores were not significantly different between the study arms. HCP Plus Peer arm participants had fewer COPD-related acute care events at 3 months ( incidence rate ratio (IRR) 0.68 ; 95% CI 0.50 - 0.93), and 6 months ( IRR 0.84 ; 95% CI 0.71 - 0.99).

CONCLUSIONS

Adding peer support to HCP support to help patients self-manage COPD, did not further improve HRQoL in this study. However, it did result in fewer COPD-related acute care events during the 6-month intervention period. Clinical trial registered with ClinicalTrials.gov (NCT02891200).

COPD: Does Inpatient Education Impact Hospital Costs and Length of Stay?

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States and costs approximately $50 billion in annual healthcare costs. Certain interventions such as COPD inpatient education programs have demonstrated effectiveness in reducing healthcare utilization and reducing healthcare associated costs. Purpose: To assess the effectiveness of chronic obstructive pulmonary disease (COPD) inpatient education using existing respiratory therapy staff in an academic health system. Methodology/Approach: This retrospective observational study employed a matched case-control design. Inpatients admitted with a COPD related condition in this study received self-management interventions from Registered Respiratory Therapists (RTs). The sample includes retrospective administrative and medical record data on 84 inpatients with a diagnosis of COPD admitted in 2016 through 2017. Patients received self-management interventions at the bedside by trained RTs while admitted to acute care areas, progressive care units and intermediate care units. Effectiveness of inpatient education was compared before and after the interventions. Hospitalization costs and length of stay (LOS) are the primary outcome measures. Results: Statistical analyses revealed that inpatient COPD education appears to reduce hospital length of stay and associated costs. Post hoc regression analyses revealed that age, gender, marital status, and number of visits were significantly associated with LOS; whereas, smoking, LOS, and number of visits were significantly associated with hospitalization costs. Practice Implications: COPD patient education may be an effective strategy at reducing hospital costs and healthcare utilization overall. Empowering patients to take responsibility for their own health outcomes by improving self-efficacy has proven to demonstrate value.

The association of self-efficacy and hospitalization rates in people with type-2 diabetes: A prospective cohort study

AIMS

Self-efficacy is presumed important in chronic disease management; we assessed the association between self-efficacy and risk of hospitalization in adults with type-2 diabetes.

METHODS

A prospective cohort was assembled between December 2011 to December 2013. Participants completed an extensive survey, including a previously validated 6-item assessment of chronic disease management self-efficacy. The association between self-efficacy (low, medium, high) and all-cause hospitalization within 1 year of the survey was assessed using multivariable logistic regression, after adjustment for sociodemographic characteristics, physical, behavioral and psychosocial factors.

RESULTS

Among the cohort (n = 1915), the average age was 64.5 (SD 10.7) years, 45.3% were women and 199 (10.4%), 459 (24.0%) and 1257 (65.6%) participants reported low, medium and high self-efficacy, respectively. Participants with low self-efficacy were younger, had more comorbidities, and followed less healthy behaviors compared to those with high self-efficacy. In unadjusted analyses, low self-efficacy was associated with increased risk of hospitalization (23.6% vs 9.6%; odds ratio (OR) 2.90: 95% confidence interval (95%CI 1.99, 4.23)) compared to those with high self-efficacy, while no significant association was observed for medium self-efficacy level (OR 1.28: 95%CI 0.91, 1.79). After adjustment, there was no difference in hospitalization risk for participants with low (OR 0.99; 95%CI 0.59, 1.67) or medium (OR 0.67; 95%CI 0.44, 1.01) self-efficacy compared to high self-efficacy.

CONCLUSIONS

Our results suggest that self-efficacy is not independently associated with lower all-cause hospitalization in this population. Focus on additional heath aspects are likely required to improve overall health outcomes in people with type-2 diabetes.

Home nursing care with the self-care model improves self-efficacy of patients with chronic obstructive pulmonary disease

AIM

This study was carried out as an intervention study to determine the effect of nursing care provided at home with the self-care model on the self-efficacy of patients with chronic obstructive pulmonary disease in northern Turkey.

METHODS

The study sample totaled 106 patients with chronic obstructive pulmonary disease divided into two groups. The intervention group and the control group each included 53 patients. To collect data, the patient data sheet, Orem's self-care model-based data collection form, symptom evaluation form, Medical Research Council dyspnea scale, and the chronic obstructive pulmonary disease self-efficacy scale (CSES) were used. The nursing care applied for the intervention group consisted of four visits, two during the first month and two for the next 2 months. An educational guidebook was distributed to the intervention group during the first visit, and at all visits, education, care, and supervision were provided according to the care plan. All data were analyzed with the number, percentage, χ(2) -test, Kruskal-Wallis H test, Wilcoxon rank sum test, and Mann-Whitney U-test.

RESULTS

The dyspnea level measured at the last visit for the control group was high compared with the intervention group (P < 0.05). The chronic obstructive pulmonary disease self-efficacy scale scores for subscale dimensions at the last visit and the general score for the intervention group were high compared with the first visit scores (P < 0.05).

CONCLUSION

According to the study results, home nursing care based on the Orem's self-care model is effective in improving self-efficacy of patients with chronic obstructive pulmonary disease.

The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies

OBJECTIVES

Self-efficacy theory, as developed by Bandura, suggests that self-efficacy is an important predictor of future behavior. The Chronic Disease Self-Management Program was designed to enhance self-efficacy as one approach to improving health behaviors and outcomes for people with varying chronic diseases. The six-item Self-Efficacy to Manage Chronic Disease Scale (SEMCD) and the four-item Spanish-language version (SEMCD-S) were developed to measure changes in self-efficacy in program participants and have been used in a numerous evaluations of chronic disease self-management programs. This study describes the development of the scales and their psychometric properties.

STUDY DESIGN AND SETTING

Secondary analyses of questionnaire data from 2,866 participants in six studies are used to quantify and evaluate the SEMCD. Data from 868 participants in two studies are used for the SEMCD-S. Subjects consisted of individuals with various chronic conditions, who enrolled in chronic disease self-management programs (either small group or Internet based). Subjects came from United States, England, Canada, Mexico, and Australia. Descriptive statistics are summarized, reliability tested (Cronbach alpha), and principal component analyses applied to items. Baseline and change scores are correlated with baseline and change scores for five medical outcome variables that have been shown to be associated with self-efficacy measures in past studies.

RESULTS

Principal component analyses confirmed the one-dimensional structure of the scales. The SEMCD had means ranging from 4.9 to 6.1 and the SEMCD-S 6.1 and 6.2. Internal consistency was high (Cronbach alpha, 0.88-0.95). The scales were sensitive to change and significantly correlated with health outcomes.

CONCLUSION

The SEMCD and SEMCD-S are reliable and appear to be valid instruments for assessing self-efficacy for managing chronic disease. There was remarkable consistency across a range of studies from varying countries using two languages.