Aim
To test a self‐management intervention in primary health care (PHC) for patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) on self‐efficacy, symptoms, ...functioning, and health.
Background
Patients with COPD or CHF experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.
Design
A multicentre randomized control trial.
Method
The trial was conducted with one intervention group (N = 73) and one control group (N = 77). The trial was performed from September 2013–September 2015 at nine PHC centres in three county councils in Sweden. At baseline patients with COPD and CHF experienced any symptom. Follow‐ups were performed after 3 months and 1 year. The intervention was structured on Bandura's theory of self‐efficacy in six meetings and individual action plans based on personal problems were performed and discussed.
Results
At baseline, there were no differences between the groups except for SF‐36 social function. After 3 months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found.
Conclusion
When designing a program, the patient's own difficulties must be taken into consideration if person‐centred care is to be established. It is feasible to include both patients with COPD and CHF in the same group in PHC. Healthcare professionals need supervision in pedagogics during intervention in self‐management.
目的
探讨慢性阻塞性肺病(COPD)或慢性心力衰竭(CHF)患者在初级卫生保健(PHC)中的自我管理干预对其自我效能、症状、功能及健康的影响。
背景
COPD或CHF患者经常出现同样的症状,如呼吸急促、咳嗽、精神不振、口干、手脚麻木或刺痛、疼痛和睡眠问题。
设计
多中心随机对照试验。
方法
实验分为干预组(数量=73)和对照组(数量=77)。试验于2013年9月至2015年9月在瑞典三个县议会的九个PHC中心进行。基线状态时,COPD和CHF患者出现任何症状。3个月和1年后进行随访。以班杜拉的自我效能理论为指导,在六次会面期间进行干预,并根据个人问题制定和探讨个人行动计划。
结果
基线时,除SF‐36社会功能外,其余各组间无显著性差异。3个月后,干预组在自己选择的活动中提高了表现和满意度,因此未发现差异。
结论
设计方案时,如果要建立以人为中心的护理,必须考虑患者自身的困难。在PHC中,将COPD和CHF患者纳入同一组是可行的。卫生保健专业人员在自我管理干预过程中需要教育监督。
Patient education in chronic obstructive pulmonary disease (COPD) is recommended in treatment strategy documents, since it can improve the ability to cope with the disease. Our aim was to identify ...the extent of and factors associated with patient education in patients with COPD in a primary health care setting.
In this nationwide study, we identified 29,692 COPD patients with a registration in the Swedish National Airway Register (SNAR) in 2019. Data on patient education and other clinical variables of interest were collected from SNAR. The database was linked to additional national registers to obtain data about pharmacological treatment, exacerbations and educational level.
Patient education had been received by 44% of COPD patients, 72% of whom had received education on pharmacological treatment including inhalation technique. A higher proportion of patients who had received education were offered smoking cessation support, had performed spirometry and answered the COPD Assessment Test (CAT), compared with patients without patient education. In the adjusted analysis, GOLD grade 2 (OR 1.29, 95% CI 1.18-1.42), grade 3 (OR 1.41, 95% CI 1.27-1.57) and grade 4 (OR 1.79, 95% CI 1.48-2.15), as well as GOLD group E (OR 1.17, 95% CI 1.06-1.29), ex-smoking (OR 1.70, 95% CI 1.56-1.84) and current smoking (OR 1.45, 95% CI 1.33-1.58) were positively associated with having received patient education, while cardiovascular disease (OR 0.92, 95% CI 0.87-0.98) and diabetes (OR 0.93, 95% CI 0.87-1.00) were negatively associated with receipt of patient education.
Fewer than half of the patients had received patient education, and the education had mostly been given to those with more severe COPD, ex- and current smokers and patients with fewer comorbidities. Our study highlights the need to enhance patient education at an earlier stage of the disease.
To investigate whether one additional educational session about inhaler use, delivered to patients with COPD in primary healthcare, could affect the patients’ skills in inhaler use. Specifically, to ...study the effects on errors related to handling the device, to inhalation technique, and to both.
This nonrandomized controlled clinical trial included 64 patients who used devices and made errors. COPD nurses assessed inhaler use using a checklist and educated patients. Intervention group received one additional educational session after two weeks.
At baseline, patients in the IG had more devices (n = 2,1) compared to patients in the CG (n = 1,6) (p = 0.003). No other statistically significant differences were seen at baseline. At follow-up, intervention group showed a lower proportion of patients who made errors related to handling the device (p = 0.006). No differences were seen in the other categories.
One additional educational session in inhaler use for patients with COPD was effective in reducing the proportion of patients making errors related to handling of their devices.
Practice implications:
Categorization of errors might help healthcare professionals to assess the suitability of patients’ devices, tailor patient education, and thus improve patient health.
•Errors in patients’ inhaler use were categorized.•Patients making errors related to handling of the device decreased after education.•The categorization gives guidance for what education in inhaler use should focus on.
Aims and objectives
To explore how spouses of patients with severe chronic obstructive pulmonary disease experience their role as informal caregiver.
Background
Informal caregiver spouses are of ...pivotal importance in the way that patients with chronic obstructive pulmonary disease cope with their daily life, including their opportunity to stay at home and avoid hospitalisations in the last stages of the disease. However, caregiving is associated with increased morbidity and mortality among caregivers. Further understanding of the role as an informal caregiver spouse of patients with severe chronic obstructive pulmonary disease is needed to develop supportive interventions aimed at reducing the caregiver burden.
Design
The study had a qualitative exploratory design. The data collection and analysis were based on framework method. Framework method is a thematic methodology and consists of five key stages: familiarisation, identifying a thematic framework, indexing, charting and mapping & interpretation.
Methods
Three focus groups were conducted in November 2013 with 22 spouses of patients with severe chronic obstructive pulmonary disease.
Results
Undefined and unpredictable responsibility was found to be the overarching theme describing the informal caregiver role. Underlying themes were: being constantly in a state of alertness, social life modified, maintaining normality, ambivalence in the relationship and a willingness to be involved.
Conclusions
The informal caregiver spouses experienced ambiguity about expectations from their private and the health professionals’ surroundings. The informal caregiver spouses wanted to provide meaningful care for their partners, but sought knowledge and support from the health professionals.
Relevance to clinical practice
We recommend that nurses take on the responsibility for including the informal caregiver spouses in those aspects of decision‐making that involve the common life of the patients and their spouses.
Aims and objective
To investigate the effects on the quality of care of the Patient Report Informing Self‐Management Support (PRISMS) form compared with usual care among patients with chronic ...obstructive pulmonary disease (COPD) consulting a COPD nurse in primary health care.
Background
Patients with COPD experience symptoms affecting their everyday lives, and there is a need for interventions in self‐management support. The delivery of chronic care in an organised, structured and planned manner can lead to more productive relationships between professionals and patients.
Design
A multicentre randomised controlled trial with a post‐test design, according to the CONSORT checklist, in one intervention group (n = 94) and one control group (n = 108).
Methods
In addition to usual care, the intervention group (n = 94) completed the PRISMS form to indicate areas where they wanted self‐management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n = 108). The primary outcome was patients’ satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t test for independent groups for interval data, and the Mann–Whitney U test for ordinal data.
Results
Participants in the intervention group were more satisfied with the QPP domains “personal attention,” regarding both “perceived reality” (p = .021) and “subjective importance” (p = .012). The PRISMS form revealed “shortness of breath” as the most commonly experienced problem and the issue most desired to discuss.
Conclusion
The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.
Relevance to clinical practice
The PRISMS form can be a useful tool in improving person‐centred care when delivering self‐management support.
Register Id
192691 at http://www.researchweb.org/is/en/sverige/project/192691.
Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth ...populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study.
This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16-23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants' quantitative Youth Health Report System data were analyzed for descriptive statistics.
Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility.
The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To compare the level of exercise self-efficacy, symptoms, functional capacity and health status and investigate the association between these variables in patients with chronic obstructive pulmonary ...disease (COPD) and chronic heart failure (CHF). Additionally, to investigate how diagnosis, symptoms and patient characteristics are associated with exercise self-efficacy in these patient groups.
Cross-sectional study.
Primary care.
Patients (n = 150) with COPD (n = 60), CHF (n = 60) and a double diagnosis (n = 30).
Swedish SCI Exercise Self-Efficacy score, modified Medical Research Council Dyspnea score (mMRC), fatigue score, pain severity score, Hospital Anxiety and Depression Scale, functional capacity measured as six-minute walking distance and health status measured by a Visual Analogue Scale.
Levels of exercise self-efficacy, health status and symptoms were alike for patients with COPD and patients with CHF. Functional capacity was similar after correction for age. Associations with exercise self-efficacy were found for slight dyspnea (mMRC = 1) (R −4.45; 95% CI −8.41- −0.50), moderate dyspnea (mMRC = 2) (−6.60;−10.68- −2.52), severe dyspnea (mMRC ≥ 3) (−9.94; −15.07- −4.80), fatigue (−0.87;−1.41- −0.32), moderate pain (−3.87;−7.52- −0.21) and severe pain (−5.32;−10.13- −0.52), symptoms of depression (−0.98;−1.42- −0.55) and anxiety (−0.65;−0,10- −0.32), after adjustment for diagnosis, sex and age.
Patients with COPD or CHF have similar levels of exercise self-efficacy, symptoms, functional capacity and health status. More severe symptoms are associated with lower levels of exercise self-efficacy regardless of diagnosis, sex and age. When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider level of symptoms than the specific diagnosis of COPD or CHF.
Key points
Exercise training is an important part of self-management in patients with COPD and chronic heart failure (CHF). High exercise self-efficacy is required for optimal exercise training.
Patients with COPD and CHF have similar symptoms and similar levels of exercise self-efficacy, functional capacity and health status.
Not the diagnosis, but symptoms of dyspnea, fatigue, pain, depression and anxiety are important factors influencing exercise self-efficacy and need to be addressed.
When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider the level of symptoms than the specific diagnosis of COPD or CHF.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Coronavirus infection disease-19 (COVID-19) can have a great impact on a person's physical functioning.
In the early course of the COVID-19 pandemic there were not any clear guidelines regarding ...rehabilitation for this group of patients.
As some people with COVID-19 may have impairments in their physical functioning up to one year after leaving hospital there is a need to provide rehabilitation.
To describe physical functioning after severe COVID-19-infection.
An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation.
At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms.
Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.
Aims and objectives
To investigate the effects of a nurse‐led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and ...exacerbation frequency over three years among patients with Chronic Obstructive Pulmonary Disease.
Background
Although Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established.
Design
A quasi‐experimental design.
Method
Primary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six‐week pulmonary rehabilitation programme. Functional capacity was assessed using a six‐minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after one year and three years. Exacerbation frequency was calculated from one year before to three years after the programme.
Results
No significant differences between the groups were observed in the six‐minute walking‐test or the Clinical COPD Questionnaire after one year and three years. On average, there were significant improvements in the six‐minute walking‐test and the Clinical COPD Questionnaire from baseline to the one‐year follow‐up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p = 0·091) but increased again in both groups after three years.
Conclusion
There was no evidence of the benefit of the nurse‐led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after one year. There is a need for support and coaching at regular follow‐ups in primary health care.
Relevance to clinical practice
There is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow‐ups.
Aim
The aim of this study was to describe inhaler use in primary health care patients with chronic obstructive pulmonary disease (COPD) and to categorize these patients into those making errors ...related to devices, those making errors related to inhalation technique and those making errors related to both.
Design
Observational study.
Methods
COPD nurses used a checklist to assess the use of inhalers by patients with spirometry‐verified COPD (N = 183) from primary healthcare centres. The STROBE checklist has been used.
Results
The mean age of the patients was 71 (SD 9) years. Almost half of them (45%) made at least one error; of these, 50% made errors related to devices, 31% made errors related to inhalation technique and 19% made errors related both to devices and to inhalation technique.
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