Home care by outreach nursing for chronic obstructive pulmonary disease

Wong, Christopher X.; Carson, Kristin; Smith, Brian J.

doi:10.1002/14651858.cd000994.pub3

Cited by 45 publications

(36 citation statements)

References 44 publications

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“…147,148 Outreach nursing programmes were not associated with a reduction in health-care resource use but there was a tendency for improved HRQoL with this intervention, although this may not be clinically significant. 150 There are few studies of the use of action plans in COPD and no evidence from these that they decrease health-care resource use or increase HRQoL 149 (see Table 53 for results from meta-analyses, Table 54 for an overall summary of findings and Figure 23 for a summary of the quantitative evidence). …”

Section: Resultsmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Resultsmentioning

confidence: 99%

“…Following the title and abstract screening, 39 articles were screened for eligibility, five of which were included in the COPD quantitative meta-review [146][147][148][149][150] ( Figure 22). …”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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“…Yapılan çalışmalar, KOAH'lı hastaların evde takibinde hemşirelerin önemine dikkat çekmiştir. Bu konuda deneyimli hemşirelerle yürütülen evde sağlık programlarının KOAH'lı hastaların ve bakı-cılarının yaşam kalitesini artırdığı, hastaneye yatış sıklığını azalttığı ve maliyet etkin olduğu gösteril-miştir [23,24]. …”

Section: Koah Gibi Solunum Sistemi Hastalıkları Olanlarunclassified

Home health services in primary care: What can we do?

Çayır¹

2013

Diclemedj

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Home health services is to give examination, diagnosis, treatment, and rehabilitation services to the patients who bedridden, have difficulties to access health facility due to a variety of chronic or malignant disease by professional health care team. Family physicians that providing health care in primary care is responsible for to determine who will need home health care services, and to make home visit on a regular basis among registered patients in their populations. It is seems that the biggest shortcoming the content and scope of this service is not yet a standard. In this article, how home health services should be given will be discussed.Key words: Primary health care, home health care, bedridden patient ÖZETEvde sağlık hizmetleri yatağa bağımlı hastalarla, çeşitli kronik ya da malign hastalıklar nedeniyle sağlık kuruluşuna erişimde güçlükler yaşayan hastalara ev ortamında muayene, tetkik, tedavi ve rehabilitasyon hizmetlerinin profesyonel bir sağlık ekibi tarafından verilmesidir. Birinci basamakta sağlık hizmeti veren aile hekimleri kayıtlı nü-fusları içinde evde sağlık hizmetine ihtiyaç duyacak kişile-ri belirlemekle ve düzenli aralıklarla ev ziyareti yapmakla sorumludur. Bu hizmetin içeriği ve kapsamı ile ilgili henüz bir standart olmaması en büyük eksiklik gibi görünüyor. Bu yazıda birinci basamakta çalışan hekimlere yönelik evde sağlık hizmetlerinin ne şekilde verilmesi gerektiği tartışılacaktır.Anahtar kelimeler: Birinci basamak sağlık hizmetleri, evde sağlık hizmetleri, yatalak hasta GİRİŞ Doğumda beklenen yaşam süresinin artması ve doğurganlık hızının azalması ile birlikte günümüz toplumu giderek yaşlanmaktadır. Türkiye de hızlı yaşlanma sürecinin beklendiği ülkelerden birisidir. 2040'a kadar Türkiye'de yaşlı nüfusta %201'lik bir artış beklenmektedir. Doğumda beklenen yaşam sü-resi 73,2 yıla ulaşmıştır [1]. Yaşlı nüfusun artması farklı sağlık hizmeti modellerini gündeme getirmiş-tir. Tüm dünyada "klinik merkezli" yerine "hasta merkezli" sağlık hizmetlerine doğru geçiş söz konusudur [2]. Bu bağlamda evde sağlık hizmetleri değişen sağlık hizmeti anlayışının bir ürünü ve değişen toplum özelliklerinin bir gereksinimi olarak ortaya çıkmıştır. Evde sağlık hizmetleri yatağa bağımlı hastalarla, çeşitli kronik ya da malign hastalıklar nedeniyle sağlık kuruluşuna ulaşımda güçlük-ler yaşayan hastalara ev ortamında muayene, tetkik, tedavi ve rehabilitasyon hizmetlerinin profesyonel bir sağlık ekibi tarafından verilmesidir [3]. Yatağa bağımlı hastalara sunulan evde sağlık hizmetleri ile hastaların yakın klinik takibi sonucunda engellenecek akut ve kronik komplikasyonlarla hastane yatışları azaltılarak ülke ve aile ekonomisine katkı sağlanacaktır [4]. Güncelliğini koruyan ve yeni şe-killenen evde sağlık hizmetlerinde birinci basamak hekimlerinin rolü önemlidir. Bu yazının amacı birinci basamak hekimlerini evde sağlık hizmetleri kapsamındaki hastaların klinik takibi ile ilgili bilgi ve farkındalıklarını artırmaktır. Hizmet kapsamıEvde sağlık hizmetlerinin kapsamı, sağlık çalı-şanlarının konuyla ilgili ...

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“…Specialised nurses have contributed to the care of patients with diabetes and COPD, and there is evidence of improvements in patient self-care, quality of life, and satisfaction [34]. A Cochrane review [35] of nursing outreach programs for COPD found significant gains in health-related quality of life for patients with moderate COPD, but the review highlighted the lack of high quality studies and concluded that further study was required.…”

Section: Introductionmentioning

confidence: 99%

“…While the role of specialist nurses in contributing to the care of patients with COPD has been examined [35-37] and some evidence of benefit in disease-specific quality of life has been found, there are few studies examining the potential role of practice nurses working in partnership with GPs in providing more coordinated, integrated, and evidence-based care for patients with newly-diagnosed COPD.…”

Section: Introductionmentioning

confidence: 99%

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

et al. 2012

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BackgroundChronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care.DesignA pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD.The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities.The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups.DiscussionThis study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care.Trial registrationACTRN12610000592044\

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Home care by outreach nursing for chronic obstructive pulmonary disease

Cited by 45 publications

References 44 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Home health services in primary care: What can we do?

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

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