BACKGROUND: The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence. METHODS: This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan. RESULTS: From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted. CONCLUSIONS: This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.
RCT Entities:
BACKGROUND: The effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence. METHODS: This was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan. RESULTS: From the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (-5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV(1) as percentage predicted. CONCLUSIONS: This study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.
Authors: Anke Lenferink; Marjolein Brusse-Keizer; Paul Dlpm van der Valk; Peter A Frith; Marlies Zwerink; Evelyn M Monninkhof; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2017-08-04
Authors: Jade Schrijver; Anke Lenferink; Marjolein Brusse-Keizer; Marlies Zwerink; Paul Dlpm van der Valk; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2022-01-10
Authors: Delphine S Tuot; Elizabeth Davis; Alexandra Velasquez; Tanushree Banerjee; Neil R Powe Journal: Am J Nephrol Date: 2013-08-21 Impact factor: 3.754
Authors: Jaap C A Trappenburg; David Schaap; Evelyn M Monninkhof; Jean Bourbeau; Gerdien H de Weert-van Oene; Theo J M Verheij; Jan-Willem J Lammers; Augustinus J P Schrijvers Journal: BMC Pulm Med Date: 2011-08-19 Impact factor: 3.317
Authors: Joanne Sloots; Mirthe Bakker; Job van der Palen; Michiel Eijsvogel; Paul van der Valk; Gerard Linssen; Clara van Ommeren; Martijn Grinovero; Monique Tabak; Tanja Effing; Anke Lenferink Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-07-15