Self-management reduces both short- and long-term hospitalisation in COPD

Ma, Gadoury; Schwartzman, Kevin; Rouleau, Michel; Maltais, François; Julien, Marcel; Beaupré, A; Renzi, Paolo; Bégin, Raymond; Nault, Diane; Bourbeau, Jean

doi:10.1183/09031936.05.00093204

Cited by 171 publications

(112 citation statements)

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“…The promise of early studies [2][3][4] was seemingly dashed by a series of negative trials [5,6] and a trial was even terminated early for fear of a detrimental effect [7]. The most recent Cochrane review, however, concludes that interventions to support self-management reduce respiratory-related and all-cause admissions, reduce dyspnoea and improve quality of life [8].…”

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confidence: 99%

Supported self-management for COPD: making progress, but there are still challenges

2016

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@ERSpublications Self-management is not a time-limited intervention but on-going support to help a person live with their condition(s) http://ow.ly/10luZqRespiratory specialists familiar with the success of supported self-management in asthma [1] may be excused for feeling disappointed by the evolution of evidence in chronic obstructive pulmonary disease (COPD). The promise of early studies [2][3][4] was seemingly dashed by a series of negative trials [5,6] and a trial was even terminated early for fear of a detrimental effect [7]. The most recent Cochrane review, however, concludes that interventions to support self-management reduce respiratory-related and all-cause admissions, reduce dyspnoea and improve quality of life [8]. The interventions in the included studies were heterogeneous and complex; and it was not possible to identify the individual components of supported self-management responsible for effective outcomes. A wider review of trial-level data was also unable to identify the most important components [9]. The study by JONKMAN et al. [10] in this issue of the European Respiratory Journal, which explores the characteristics of effective self-management interventions in an individual patient data meta-analysis, is therefore a useful contribution to the literature. Difficulty identifying early exacerbationsIn retrospect, the clues that self-management in COPD would be more challenging than in asthma were already available. From the health service perspective, one of the main goals of self-management is to enable patients to recognise that their condition is deteriorating and take timely, appropriate action that can prevent further development of an exacerbation and reduce the risk of an admission. However, qualitative studies in people with COPD highlight the difficulty people have in distinguishing "bad days" from the onset of an exacerbation, observing that it is "only afterwards that you know you are not well" [11]. When asked about the symptoms that indicate an exacerbation, many patients describe nebulous symptoms of "just feeling rough" [12], an observation that will resonate with any general practitioner who has been asked to visit a COPD patient in the throes of an exacerbation whose complaint is no more specific than "unwell". Analysis of telemonitoring data suggests that it is the minority of patients who can log discrete episodes of increased breathlessness, cough and purulent sputum [13]. Most experience a rolling pattern of on-going symptoms with little clarity on when treatment is appropriate. This difficulty in distinguishing the onset of an exacerbation may be one reason for the negative findings of BUCKNELL et al. [6] in their trial of self-management. They observed that only 42% of participants were "successful self-managers" and, in a post hoc analysis, showed that the intervention was effective in this sub-group. CALVERLEY et al. [14] predicted this difficulty a decade ago from analysis of diary cards from trial participants. Despite an increase in mean symptom scores, on an indi...

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confidence: 99%

Supported self-management for COPD: making progress, but there are still challenges

2016

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“…This programme resulted in a 39% reduction in admissions and a 41% reduction in visits to the emergency department. The benefits of education and self-management were maintained in the medium term [47]. These interventions demonstrate some common factors: the role of the nurse, and intervention in the patient's home.…”

Section: Prevention Of Hospital Admissionmentioning

confidence: 95%

Discharge planning and home care for end-stage COPD patients

Escarrabill¹

2009

Eur Respir J

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Discharge support for the most seriously ill chronic obstructive pulmonary disease (COPD) patients is a key issue in minimising the impact of the acute episode and preventing future relapses.Alternatives to hospitalisation are crucial in the cost minimisation of COPD care. However, besides efficiency, there are clinical reasons for promoting alternatives to conventional hospital admission. Hospital stay itself conveys a risk to patients.The discharge process is a key element in the healthcare continuum. Hospital at home is a safe alternative to hospital admission, but it is not the only means of supporting discharge. Some home care schedules, mainly supported by nurses, have been proven to be good alternatives.Home care is also useful in the prevention of hospital admission. Integrated care is a comprehensive response to the needs of severely affected COPD patients achieved through models of shared care utilising all relevant health providers and promoting self-management. The framework for integrated care is the so-called chronic care model, centred on the promotion of self-management, the holistic appraisal of the patient, the most appropriate design of healthcare delivery responding effectively to the needs of the patient and a good system of shared and accessible information.

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“…Other components of PR, such as disease-specific education and strategies for selfmanagement, have been shown to be effective in increasing knowledge 11 and decreasing hospitalizations and emergency visits. 12 There is a potential for these components of PR to be implemented in NPR programmes.…”

Section: Janaudis-ferreira Et Al Prevalence and Characteristics Of Cmentioning

confidence: 99%

Prevalence and Characteristics of Patients with a Diagnosis of Chronic Obstructive Pulmonary Disease Participating in Non-Pulmonary Rehabilitation Programmes: A Brief Report

Janaudis-Ferreira

D’Souza

Brooks

et al. 2014

Physiotherapy Canada

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Purpose: To determine the prevalence of people with a diagnosis of chronic obstructive pulmonary disease (COPD) among those completing nonpulmonary rehabilitation (NPR) programmes and to describe their characteristics. Methods: Electronic data of participants who completed an in-patient rehabilitation programme between July 1, 2010, and July 1, 2012 were retrospectively reviewed. Data extracted were month and year of birth, sex, height, weight, referral source, admission and discharge dates, programme admitted to, reason for admission, most responsible health condition, number of co-morbidities, referral agency on discharge, and Functional Independence Measure (FIM) scores on admission and discharge. Results: The prevalence of COPD among participants who completed the NPR programmes was 7.5%. The most common reasons for admission were cardiac conditions (n ¼ 69, 20%), followed by post-unilateral hip replacement (n ¼ 40, 11%) and post-unilateral hip fracture (n ¼ 38, 11%). Patients were discharged after an average stay of 20 (SD 13) days. The mean FIM score was 91 (SD 11) at admission and 108 (SD 9) at discharge. Conclusions: The prevalence of a COPD diagnosis among participants in NPR programmes was 7.5%. COPD is a common comorbidity for people in rehabilitation programmes who have had amputations, have a cardiac condition, have undergone organ transplantation, or require complex care.Key Words: chronic obstructive pulmonary disease; prevalence; rehabilitation. RÉ SUMÉObjectif : É tablir la pré valence des personnes atteintes d'une MPOC chez celles qui effectuent un programme de ré adaptation non pulmonaire et dé crire leurs caracté ristiques. Mé thodes : Examen ré trospectif de donné es informatisé es au sujet de participants hospitalisé s ayant terminé un programme de ré adaptation entre le 1 er juillet 2010 et le 1 er juillet 2012. Les donné es extraites é taient les suivantes: mois et anné e de naissance, sexe, grandeur, poids, source de ré fé rence, date d'admission et date du congé , programme effectué , raison de l'admission, problè me de santé principal, nombre de comorbidité s, agence d'aiguillage au moment du congé , note de la mesure d'indé pendance fonctionnelle (MIF) à l'admission et au moment du congé . Ré sultats : La pré valence de MPOC chez les participants ayant terminé un programme de ré adaptation non pulmonaire é tait de 7,5%. La raison la plus fré quente de l'admission é tait un trouble cardiaque (n ¼ 69,20%), suivi d'une arthroplastie unilaté rale de la hanche (n ¼ 40,11%) et d'une fracture unilaté rale à la hanche (n ¼ 38,11%). Les patients ont obtenu leur congé aprè s un sé jour moyen de 20 (13) jours. La note moyenne de la MIF é tait de 91 (ET 11) à l'admission et de 108 (9) au moment du congé . Conclusions : La pré valence de MPOC chez les participants à un programme de ré adaptation non pulmonaire é tait de 7,5%. La MPOC est une comorbidité fré quente dans les programmes de ré adaptation destiné s aux personnes qui ont subi une amputation ou une greffe d'organe, qui sont aux p...

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Self-management reduces both short- and long-term hospitalisation in COPD

Cited by 171 publications

References 10 publications

Supported self-management for COPD: making progress, but there are still challenges

Supported self-management for COPD: making progress, but there are still challenges

Discharge planning and home care for end-stage COPD patients

Prevalence and Characteristics of Patients with a Diagnosis of Chronic Obstructive Pulmonary Disease Participating in Non-Pulmonary Rehabilitation Programmes: A Brief Report

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