Efficient integrated education for older patients with chronic obstructive pulmonary disease using the Lung Information Needs Questionnaire

Wakabayashi, Ritsuko; Motegi, Takashi; Yamada, Kazutoyo; Ishii, Takeo; Jones, Rupert; Hyland, Michael E.; Gemma, Akihiko; Kida, Kenji

doi:10.1111/j.1447-0594.2011.00696.x

Cited by 46 publications

(35 citation statements)

References 25 publications

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“…Díaz Lobato 133 Man 148 Martin 134 McGeoch 135 Rea 117 Rice 137 Ries 138 Seymour 139 Smith 140 Soler 143 Sridhar 142 Tougaard 143 Trappenburg 144 Wakabayashi 145 Wong 146 Wood- Baker 147 Overall (I 2 = 37.4%, p = 0.017) The details of the characteristics of each included study are summarised in Table 8 and further details are available in Blakemore et al 112 Table 9 shows the characteristics of the different interventions employed in each study in the review. Figure 14 shows the combined effect across the 39 independent studies.…”

Section: -181mentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: -181mentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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“…En el 45,5% (n=10) de los estudios fueron mayoría los hombres, frente a un 40,9% (n=9) donde la mayor prevalencia eran mujeres y en un 13,6% (n=3) fue equitativo el reparto entre sexos, todos los estudios llevados a cabo en España muestra unas diferencias muy significativas de la prevalencia de la EPOC en el sexo masculino. La media de edad de todos los estudios es de 66,4 años, siendo la comorbilidad más frecuente las enfermedades coronarias, de los estudios que así lo analizaron (n=5) (45,46,60,67,73) . En uno de los estudios que así lo recogen afirman que el 90% de los pacientes se vacunó contra la gripe el año anterior, no teniendo los resultados de incidencia de la vacunación tras la implementación del programa de educación terapéutica (47) .…”

Section: Participantes/ Reclutamientounclassified

“…En todos los estudios, salvo uno (64) , el modo de educación fue grupal, en algunos de los casos además se realizó de un plan individual (n=9) (45,46,48,55,60,64,71,73,74) , uso de folletos informativos para reforzar la educación (n=8) (5,45,48,53,54,60,67,71) , seguimiento telefónico (n=3) (45,70,71) o utilización de diario (n=3) (50,53,71) . El contenido de las sesiones educativas fue: en 18 artículos (81,8%) en sus sesiones educativas hablan sobre el conocimientos sobre la EPOC, con los siguientes componentes: anatomía y fisiología (n=3) (50,54,63) , descripción de la enfermedad (n=10) (5,(45)(46)(47)49,55,60,64,67,70) , signos y síntomas de la EPOC (n=3) (54,57,74) , signos y síntomas de las exacerbaciones (n=10) (50,54,55,57,60,63,64,…”

Section: Intervencionesunclassified

“…Otro de los apartados fue el tratamiento no farmacológico abordado en 19 estudios (86,4%), con los siguientes componentes: deshabituación tabáquica (n=15) (5,45,46,48,(53)(54)(55)57,60,(62)(63)(64)67,71,73) , práctica regular de ejercicio físico (n=9) (5,46,48,49,54,55,60,63,71) , hábitos nutricionales (n=10) (5,(46)(47)(48)(49)53,55,60,62,71) , control de las emociones (n=3) (49,55,71) , gestión de la disnea (n=3) (49,55,71) , técnicas de respiración (n=6) (45,47,55,63,70,71) , sueño y Artículos localizados con la estrategia "COPD "and "EDUCATION" N= 321…”

Section: Intervencionesunclassified

“…parámetro, pero tampoco lo empeora (45,60,62) y solo en uno de ellos ha mejorado tras la intervención educativa (5) . 6 6,0 H 1 = + = * En la variable sexo, se ha medido el sexo más predominante en la investigación el valor H hace referencia a los hombres y e l valor M hace referencia a las mujeres.…”

Section: Nº 45 Enero 2017unclassified

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Programas educativos en pacientes con Enfermedad Pulmonar Obstructiva Crónica. Revisión integradora

Folch

Orts-Cortés

Hernández-Carcereny

et al. 2016

eglobal

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RESUMENSegún la OMS, el objetivo de la educación terapéutica (ET) es ayudar al paciente a adquirir los recursos necesarios para gestionar óptimamente su vida con una enfermedad crónica. La ET forma parte del tratamiento en la prevención secundaria y terciaria. La última revisión de la Cochrane ha demostrado resultados positivos, sin embargo, la heterogeneidad de las poblaciones, tipo de intervenciones y medidas de resultado hace que sea difícil establecer recomendaciones claras en este ámbito. Así como se desconoce qué instrumentos son los recomendables para evaluar el cumplimiento terapéutico en la EPOC. Por tanto es necesario realizar de una revisión con el objetivo de conocer las características de los ensayos clínicos, el perfil del paciente EPOC, los contenidos de la ET y las variables estudiadas en los mismos. Identificándose 22 ensayos clínicos con una alta calidad metodológica, escala Jadad >3 que mostraron que en los ensayos clínicos de programas de ET las variables más estudiadas son la calidad de vida, ingresos hospitalarios y las variables de función pulmonar, donde la ET disminuye los ingresos hospitalarios, favorece la deshabituación tabáquica, mejora los conocimientos de la EPOC cuyas intervenciones son sesiones grupales, con diferentes materiales educativos, existiendo un auge en el número de publicaciones en este ámbito. Existe una gran variedad en los instrumentos de evaluación y heterogeneidad de las intervenciones, para establecer conclusiones. Palabras clave: EPOC; educación en salud ABSTRACTAccording to WHO, the aim of therapeutic education (TE) is help the patient to acquire the resources necessary to optimally manage your life with a chronic disease. The TE is part of treatment in secondary and tertiary prevention. The latest Cochrane review has shown positive results however,

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