Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: a randomised controlled trial

Abstract

ObjectivesTo assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease (COPD).DesignCluster randomised controlled trial.SettingTasmanian general practices: capital city (11), large rural (3), medium rural (1) and small rural (16).ParticipantsPatients were invited (1207) from general practitioner (GP) databases with COPD diagnosis and/or tiotropium prescription, response rate 49% (586), refused (176) and excluded (criteria: smoking history or previous study, 68). Spirometry testing (342) confirmed moderate or severe COPD in 182 (53%) patients.RandomisationBy random numbers code, block stratified on location, allocation by sequentially numbered, opaque and sealed envelopes.InterventionHealth mentor (HM) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting: problem solving, decision-making and action planning. Control: usual care (UC) group received GP care plus non-interventional brief phone calls.OutcomesMeasured at 0, 6 and 12 months, the Short Form 36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ, primary); Partners In Health (PIH) Scale for self-management capacity, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies-Depression (CES-D) questionnaire, Post-Traumatic Stress Disorder Checklist, Satisfaction with life and hospital admissions (secondary).Results182 participants with COPD (age 68±8 years, 62% moderate COPD and 53% men) were randomised (HM=90 and UC=92). Mixed model regression analysis accounting for clustering, adjusting for age, gender, smoking status and airflow limitation assessed efficacy (regression coefficient, β, reported per 6-month visit). There was no difference in quality of life between groups, but self-management capacity increased in the HM group (PIH overall 0.15, 95% CI 0.03 to 0.29; knowledge domain 0.25, 95% CI 0.00 to 0.50). Anxiety decreased in both groups (HADS A 0.35; 95% CI −0.65 to −0.04) and coping capacity improved (PIH coping 0.15; 95% CI 0.04 to 0.26).ConclusionsHealth mentoring improved self-management capacity but not quality of life compared to regular phone contact, which itself had positive effects where decline is generally expected.

Evaluation of a Nurse-Led Educational Telephone Intervention to Support Self-Management of Patients With Chronic Obstructive Pulmonary Disease: A Randomized Feasibility Study

“…No training was required and thus the intervention also compares favorably with other studies whose interventions have required up to two days of nurse training (22). However, as the study by Walters et al (22) used community nurses to conduct the intervention, they needed to be orientated to both the condition of COPD as well as the intervention.…”

“…No training was required and thus the intervention also compares favorably with other studies whose interventions have required up to two days of nurse training (22). However, as the study by Walters et al (22) used community nurses to conduct the intervention, they needed to be orientated to both the condition of COPD as well as the intervention. As most primary care nurses in the UK are qualifi ed in chronic disease management, many will have an additional qualifi cation in Asthma or COPD, and thus could deliver the intervention under investigation with minimal extra training.…”

Therapeutic strategy to prevent acute exacerbations of chronic obstructive pulmonary disease: clinical guidelines of American College of Chest Physicians and Canadian Thoracic Society Guideline (Part 1)

“…В 12 исследованиях представлены оригинальные данные по оценке влияния обучения в сочетании с письменным планом действий и инди видуальным ведением больного на госпитализации и обращения за неотложной помощью. Результаты исследований [104][105][106][107][108][109][110][111] были объединены в мета анализ для оценки влияния этих методик на госпи тализации. В исследованиях [104,[107][108][109] также содержатся данные, необходимые для метаанализа и оценки влияния этих методик на обращения за неотложной помощью.…”

“…В 2 исследованиях оценивалась разница в госпитализациях и обраще ниях за неотложной помощью в целом, тогда как в остальных исследованиях анализировались только обострения ХОБЛ. В исследованиях, включенных в метаанализ, приведено влияние 12 месячного ве дения больных на госпитализации [104][105][106][107][108][109]111], в 1 исследовании длительность наблюдения состави ла 6 мес. [110].…”

Resilience in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure

“…With regard to the application of resilience based interventions, health care professionals using a person centered approach may be ideally placed to assess and provide interventions to enhance resilience in those adults who have a chronic disease and a reduced level of resilience [31] through strategies such as motivational interviewing. Motivational interviewing has been shown to enhance self-management abilities of people with COPD [45].…”