Therapeutic paralysis in Veterans with COPD

Abstract

Summary Background Chronic Obstructive Pulmonary Disease (COPD) is a common disorder of Veterans that causes significant morbidity and mortality. To measure Veterans’ perceptions about COPD, the effect of COPD on their lives and health, and their needs for improved health, we performed a postal survey. Methods 3263 Veterans with a diagnosis of COPD who received care at the Cincinnati Veterans Affairs Medical Center in 2008 were stratified into quintiles by Veterans Health Administration - associated COPD healthcare cost and uniformly sampled. Results 493 of 1000 surveys (49%) were completed and returned. COPD had different effects on respondents in top and bottom quintiles (highest and lowest COPD-related cost) for: knowledge of COPD diagnosis (89% vs 73%, p=0.03); activities affected by breathing, including work (69% vs 45%), recreation (85% vs 62%), change in living arrangements (36% vs 16%), and increased need for help (54% vs 25%) (p<0.05 for all comparisons); emotional effect of respiratory symptoms, including depression (53% vs 30%), fear (41% vs 15%), and helplessness (49% vs 24%) (p<0.05 for all comparisons). 91% of Veterans were prescribed inhalers and one quarter had difficulties using them. 25% of Veterans did nothing when they had symptoms of an exacerbation. Conclusions COPD has profound effects on Veterans’ breathing related activities and generates many negative emotions. Primary care providers are critical in conveying the diagnosis of COPD and providing information about the disease and its management. Veterans with COPD adhere poorly to their medications, and report little instruction about COPD or its management.

A Tablet-Based Multimedia Education Tool Improves Provider and Subject Knowledge of Inhaler Use Techniques

“…All 50 subjects completed a questionnaire based upon the COPD Health Determinants survey. 13 Ninety-two percent of subjects received all of their care at the Cincinnati VAMC. Thirty-seven (74%) reported that they took their inhalers as prescribed, and 34 (68%) previously received inhaler use instruction.…”

“…Then they viewed the videos for those inhalers and were retested in a similar fashion as the providers. At the initial encounter, subjects completed a demographics questionnaire, COPD Health Determinants survey, 13 and the COPD Assessment Test. 14 After 3-6 months,…”