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Brugnolli A, Chini G, Scartezzini R, Ambrosi E. Qualitative study of COVID-19 patient experiences with non-invasive ventilation and pronation: strategies to enhance treatment adherence. BMJ Open 2023; 13:e077417. [PMID: 38070911 PMCID: PMC10729144 DOI: 10.1136/bmjopen-2023-077417] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation (NIV) treatment combined with pronation in patients with COVID-19 respiratory failure has been shown to be effective in improving respiratory function and better patient outcomes. These patients may experience discomfort or anxiety that may reduce adherence to treatment. OBJECTIVE The aim of this study was to explore and describe the subjective experiences of patients undergoing helmet NIV and pronation during hospitalisation for COVID-19 respiratory failure, with a focus on the elements of care and strategies adopted by patients that enabled good adaptation to treatments. METHOD A qualitative descriptive study, using face-to-face interviews, was carried out with a purposeful sample of 20 participants discharged from a pulmonary intensive care unit who underwent helmet continuous positive airway pressure and pronation during hospitalisation for COVID-19. RESULTS Content analysis of the transcripts revealed feelings and experiences related to illness and treatments, strategies for managing one's own negative thoughts, and practical strategies of one's own and healthcare workers to facilitate adaptation to pronation and helmet. Experience was reflected in five major topics related to specific time points and settings: feelings and experiences, helmet and pronation: heavy but beneficial, positive thinking strategies, patients' practical strategies, support of healthcare professionals (HCPs). CONCLUSIONS This study may be useful to HCPs to improve the quality and appropriateness of care they provide.
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Affiliation(s)
- Anna Brugnolli
- Campus of health sciences, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Gabriele Chini
- Risorse Umane - Polo universitario delle Professioni Sanitarie di Trento, Trento Provincial Authority for Health Services, Trento, Italy
| | - Riccardo Scartezzini
- Pneumology department, Trento Provincial Authority for Health Services, Trento, Italy
| | - Elisa Ambrosi
- Dipartimento di Diagnostica e Sanità Pubblica, Università degli Studi di Verona, Verona, Italy
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2
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Raveling T, Rantala HA, Duiverman ML. Home ventilation for patients with end-stage chronic obstructive pulmonary disease. Curr Opin Support Palliat Care 2023; 17:277-282. [PMID: 37646583 PMCID: PMC10597445 DOI: 10.1097/spc.0000000000000671] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF THE REVIEW The number of patients with end-stage chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV) has greatly increased. In this review, the authors summarize the evidence for nocturnal NIV and NIV during exercise. The authors discuss the multidisciplinary and advanced care of patients with end-stage COPD treated with NIV. RECENT FINDINGS Nocturnal NIV improves gas exchange, health-related quality of life and survival in stable hypercapnic COPD patients. Improvements in care delivery have been achieved by relocating care from the hospital to home based; home initiation of chronic NIV is feasible, non-inferior regarding efficacy and cost-effective compared to in-hospital initiation. However, the effect of NIV on symptoms is variable, and applying optimal NIV for end-stage COPD is complex. While exercise-induced dyspnoea is a prominent complaint in end-stage COPD, nocturnal NIV will not change this. However, NIV applied solely during exercise might improve exercise tolerance and dyspnoea. While chronic NIV is often a long-standing treatment, patient expectations should be discussed early and be managed continuously during the treatment. Further, integration of advance care planning requires a multidisciplinary approach. SUMMARY Although chronic NIV is an effective treatment in end-stage COPD with persistent hypercapnia, there are still important questions that need to be answered to improve care of these severely ill patients.
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Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heidi A. Rantala
- Department of Respiratory Medicine
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation
- Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Ambrosino N, Nava S. How to Speak to Patients. Arch Bronconeumol 2023; 59:712-713. [PMID: 37620185 DOI: 10.1016/j.arbres.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Affiliation(s)
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
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Fuentes A, Amat C, Lozano-Rubí R, Frid S, Muñoz M, Escarrabill J, Grau-Corral I. mHealth Technology as a Help Tool during Breast Cancer Treatment: A Content Focus Group. Int J Environ Res Public Health 2023; 20:4584. [PMID: 36901594 PMCID: PMC10001870 DOI: 10.3390/ijerph20054584] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess the usability and preferences of the contents of mHealth software developed for breast cancer patients as a tool to obtain patient-reported outcomes (PROMs), improve the patient's knowledge about the disease and its side effects, increase adherence to treatment, and facilitate communication with the doctor. INTERVENTION an mHealth tool called the Xemio app provides side effect tracking, social calendars, and a personalized and trusted disease information platform to deliver evidence-based advice and education for breast cancer patients. METHOD A qualitative research study using semi-structured focus groups was conducted and evaluated. This involved a group interview and a cognitive walking test using Android devices, with the participation of breast cancer survivors. RESULTS The ability to track side effects and the availability of reliable content were the main benefits of using the application. The ease of use and the method of interaction were the primary concerns; however, all participants agreed that the application would be beneficial to users. Finally, participants expressed their expectations of being informed by their healthcare providers about the launch of the Xemio app. CONCLUSION Participants perceived the need for reliable health information and its benefits through an mHealth app. Therefore, applications for breast cancer patients must be designed with accessibility as a key consideration.
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Affiliation(s)
| | - Clara Amat
- Fundació Clínic per a la Recerca Biomèdica, 08036 Barcelona, Spain
| | | | - Santiago Frid
- Medical Informatics Unit, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Montserrat Muñoz
- Oncology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Joan Escarrabill
- Patient Xperience, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Imma Grau-Corral
- Fundación iSYS, 08028 Barcelona, Spain
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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5
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Winck JC, Ambrosino N. Tele-Medicine: The Search of the Holy Grail. Arch Bronconeumol 2023:S0300-2896(23)00026-1. [PMID: 36803936 DOI: 10.1016/j.arbres.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
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Catalán À, Gastaldo I, Roura E, Massanes T, Escarrabill J, Moizé V. Influence of Nutrition Training, Eating Habits, and Culinary Skills of Health Care Professionals and Its Impact in the Promotion of Healthy Eating Habits. TOP CLIN NUTR 2023; 38:66-76. [DOI: 10.1097/tin.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ribeiro C, Jácome C, Oliveira P, Conde S, Windisch W, Nunes R. Patients experience regarding home mechanical ventilation in an outpatient setting. Chron Respir Dis 2022; 19:14799731221137082. [PMID: 36417310 PMCID: PMC9706049 DOI: 10.1177/14799731221137082] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.
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Affiliation(s)
- Carla Ribeiro
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal,Carla Ribeiro, Pulmonology Department,
Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n,
Vila Nova de Gaia 4434-502, Portugal.
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS,
Faculty of
Medicine of the University of Porto,
Porto, Portugal
| | - Pedro Oliveira
- ISPUP-EPI Unit, Instituto de
Ciências Biomédicas de Abel Salazar, Universidade do
Porto, Portugal
| | - Sara Conde
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Faculty of Health/School of
Medicine, Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt
Köln gGmbH, Witten/Herdecke University, Cologne,
Germany
| | - Rui Nunes
- Faculty of Medicine,
University
of Porto, Porto, Portugal
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Annaka H, Nomura T, Moriyama H. Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study. Int J Environ Res Public Health 2022; 19:10708. [PMID: 36078424 PMCID: PMC9517874 DOI: 10.3390/ijerph191710708] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
- Graduate School, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hiroshi Moriyama
- Respiratory Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
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Bueno GH, Campos CJG, Turato ER, Paschoal IA, Valladão LS, Baltieri L, Martins LC. Experiences in elderly people with chronic obstructive pulmonary disease in relation to the use of long-term home oxygen therapy: a qualitative study about feelings attributed to therapy. BMC Pulm Med 2022; 22:96. [PMID: 35305608 PMCID: PMC8933854 DOI: 10.1186/s12890-022-01891-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background Elderly people are more likely to suffer severe chronic obstructive pulmonary disease (COPD) and require long-term home oxygen therapy (LTOT) as part of their treatment. LTOT has advantages such as improvement in symptoms, but there are also disadvantages such as physical barriers, psychosocial barriers and emotional challenges. The aim of this study is to understand the experiences of elderly people with COPD using LTOT with respect to their feelings attributed to therapy. Methods Qualitative study. Seven semidirected interviews were conducted with patients with a confirmed COPD diagnosis who used LTOT and were treated at an outpatient service. The content analysis technique was applied with the support of WebQDA software 2.0. Results Three categories emerged that were associated with the use of LTOT: (1) poor self-image; (2) feelings of sadness and (3) the impact of LTOT on others such as family and friends. Conclusions LTOT in elderly people with COPD was associated with a poor self-image, feelings of sadness and impacted on others apart from the patient. When LTOT is prescribed, healthcare practitioners should proactively address these concerns to minimise the negative biopsychosocial experiences caused by LTOT.
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Souto-Miranda S, Dias C, Jácome C, Melo E, Marques A. Long-Term Maintenance Strategies after Pulmonary Rehabilitation: Perspectives of People with Chronic Respiratory Diseases, Informal Carers, and Healthcare Professionals. Healthcare (Basel) 2022; 10:healthcare10010119. [PMID: 35052283 PMCID: PMC8775561 DOI: 10.3390/healthcare10010119] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation (PR) is an effective intervention for people with chronic respiratory diseases (CRD); however, its effects fade after 6–12 months. Community-based strategies might be valuable to sustain PR benefits, but this has been little explored. People with CRD, informal carers, and healthcare professionals (HCPs) were recruited from pulmonology appointments of two local hospitals, two primary care centres, and one community institutional practice and through snowballing technique. Focus groups were conducted using a semi-structured guide. Data were thematically analysed. Twenty-nine people with CRD (24% female, median 69 years), 5 informal carers (100% female, median 69 years), and 16 HCPs (75% female, median 36 years) were included. Three themes were identified: “Maintaining an independent and active lifestyle” which revealed common strategies adopted by people with “intrinsic motivation and professional and peer support” as key elements to maintain benefits, and that “access to information and partnerships with city councils’ physical activities” were necessary future steps to sustain active lifestyles. This study suggests that motivation, and professional and peer support are key elements to maintaining the benefits of PR in people with CRD, and that different physical activity options (independent or group activities) considering peoples’ preferences, should be available through partnerships with the community, namely city councils.
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Affiliation(s)
- Sara Souto-Miranda
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- iBiMED—Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Cláudia Dias
- Home Care Department, Linde Healthcare, 1200-217 Lisbon, Portugal;
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Elsa Melo
- iBiMED—Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Alda Marques
- Lab3R—Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence:
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Caneiras C, Jácome C, Oliveira D, Moreira E, Dias CC, Mendonça L, Mayoralas-Alises S, Fonseca JA, Diaz-Lobato S, Escarrabill J, Winck JC. The Portuguese Model of Home Respiratory Care: Healthcare Professionals' Perspective. Healthcare (Basel) 2021; 9:1523. [PMID: 34828569 PMCID: PMC8623333 DOI: 10.3390/healthcare9111523] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Patients' and carers' views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients' late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients' education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model.
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Affiliation(s)
- Cátia Caneiras
- Microbiology Research Laboratory on Environmental Health (EnviHealthMicro Lab), Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Institute for Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Healthcare Department, Nippon Gases Portugal, 2600-242 Vila Franca de Xira, Portugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Daniela Oliveira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Rheumatology Department, Centro Hospitalar Universitário São João (CHUSJ), 4200-319 Porto, Portugal
| | - Emília Moreira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Liliane Mendonça
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
| | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (C.J.); (D.O.); (E.M.); (C.C.D.); (L.M.); (J.A.F.)
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF Porto, 4460-188 Matosinhos, Portugal
| | - Salvador Diaz-Lobato
- Healthcare Department, Nippon Gases Spain, 28020 Madrid, Spain;
- Service of Pneumology, Hospital Universitario Moncloa, 28008 Madrid, Spain
| | - Joan Escarrabill
- Programa de Atención a la Cronicidad, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
- Master Plan for Respiratory Diseases (Ministry of Health) & Observatory of Home Respiratory Therapies (FORES), 08028 Barcelona, Spain
- REDISSEC Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - João Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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