Myriam Gagné1,2,3, Sophie Lauzier4,5, Justine Babineau-Therrien1,2, Christine Hamel6,7, Sara-Edith Penney3, Jean Bourbeau3,8,9, Jocelyne Moisan4,5, Louis-Philippe Boulet10,11,12,13. 1. Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Université Laval, Québec, QC, Canada. 2. Quebec Heart and Lung Institute, Université Laval, 2725, Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada. 3. Québec Respiratory Health Education Network, Québec, QC, Canada. 4. Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada. 5. Faculty of Pharmacy, Université Laval, Québec, QC, Canada. 6. Centre de recherche et intervention sur la réussite scolaire, Québec, QC, Canada. 7. Faculty of Education, Université Laval, Québec, QC, Canada. 8. Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, McGill University, Montréal, QC, Canada. 9. Faculty of Medicine, McGill University, Montréal, QC, Canada. 10. Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Université Laval, Québec, QC, Canada. lpboulet@med.ulaval.ca. 11. Quebec Heart and Lung Institute, Université Laval, 2725, Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada. lpboulet@med.ulaval.ca. 12. Québec Respiratory Health Education Network, Québec, QC, Canada. lpboulet@med.ulaval.ca. 13. Faculty of Medicine, Université Laval, Québec, QC, Canada. lpboulet@med.ulaval.ca.
Abstract
BACKGROUND: There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. METHODS: We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPD patients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. RESULTS: Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). CONCLUSIONS: Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits. CLINICAL TRIALS REGISTRATION NO: NCT02870998.
BACKGROUND: There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. METHODS: We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPDpatients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. RESULTS: Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). CONCLUSIONS: Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits. CLINICAL TRIALS REGISTRATION NO: NCT02870998.
Authors: Elizabeth Maunsell; Sophie Lauzier; Jennifer Brunet; Sylvie Pelletier; Richard H Osborne; H Sharon Campbell Journal: Cancer Date: 2014-07-02 Impact factor: 6.860
Authors: A Lewis; S Torvinen; P N R Dekhuijzen; H Chrystyn; A T Watson; M Blackney; A Plich Journal: BMC Health Serv Res Date: 2016-07-12 Impact factor: 2.655