Alexandra Strassmann1, Mathias Guler2, Claudia Steurer-Stey3, Kaba Dalla Lana1, Tania Carron4, Julia Braun1, Philippe Giroud2, Isabelle Peytremann-Bridevaux4, Milo A Puhan1, Anja Frei5. 1. Epidemiology, Biostatistics und Prevention Institute, University of Zurich, Zurich, Switzerland. 2. Swiss Lung Association, Berne, Switzerland. 3. Epidemiology, Biostatistics und Prevention Institute, University of Zurich, Zurich, Switzerland; mediX Group practice, Zurich, Switzerland. 4. Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. 5. Epidemiology, Biostatistics und Prevention Institute, University of Zurich, Zurich, Switzerland. Electronic address: anja.frei@uzh.ch.
Abstract
OBJECTIVE: To evaluate the nationwide implementation of the "Living well with COPD" program by the Swiss Lung Association in various cantons in Switzerland. METHODS: For the process evaluation, we used qualitative (interview, focus group) and quantitative (questionnaires, documentation analysis) methods to assess the implementation outcomes reach, dose, fidelity and acceptability. For the effectiveness, we performed a pre-post analysis of patient data collected at baseline and program end (after 14 months). RESULTS: Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients. Patients' attendance rate was 81% and coaches' fidelity to protocol 94%. Acceptance and satisfaction of all involved persons was high. Integration of the coaches' additional workload, uncertainties regarding roles and responsibilities and sustainable reimbursement were major challenges. Patients significantly improved in COPD specific quality of life and increased exercise capacity with on average 3.2 more repetitions in the 1-minute sit-to-stand test. CONCLUSION: The program was successfully implemented throughout Switzerland with high acceptability and positive association with patients' quality of life. PRACTICE IMPLICATIONS: Our findings support the broader multiplication throughout Switzerland and serves the international community since it is one of the first nationwide implementations beyond study settings.
OBJECTIVE: To evaluate the nationwide implementation of the "Living well with COPD" program by the Swiss Lung Association in various cantons in Switzerland. METHODS: For the process evaluation, we used qualitative (interview, focus group) and quantitative (questionnaires, documentation analysis) methods to assess the implementation outcomes reach, dose, fidelity and acceptability. For the effectiveness, we performed a pre-post analysis of patient data collected at baseline and program end (after 14 months). RESULTS: Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients. Patients' attendance rate was 81% and coaches' fidelity to protocol 94%. Acceptance and satisfaction of all involved persons was high. Integration of the coaches' additional workload, uncertainties regarding roles and responsibilities and sustainable reimbursement were major challenges. Patients significantly improved in COPD specific quality of life and increased exercise capacity with on average 3.2 more repetitions in the 1-minute sit-to-stand test. CONCLUSION: The program was successfully implemented throughout Switzerland with high acceptability and positive association with patients' quality of life. PRACTICE IMPLICATIONS: Our findings support the broader multiplication throughout Switzerland and serves the international community since it is one of the first nationwide implementations beyond study settings.
Keywords:
Chronic obstructive pulmonary disease; Living well with COPD; Mixed-methods evaluation; Patient education; Program implementation; Self-management