COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study
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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.
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.
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).
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.
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The authors thank Alexandra Lauzier, M.Sc., Patricia Côté, M.A., and Justine Veilleux, undergraduate medical student, for help in data collection. They wish to thank Serge Simard, M.Sc. for assistance in conducting statistical analyses and Stéphanie Charest, M.Sc. Ph.D.(c) for performing the qualitative data analysis. We are grateful to Barbara Pattison, C. Tr. for translating verbatim transcripts from French to English and to Erica Pridoehl, M.Ed. for editing the manuscript. Finally, the authors wish to thank all respiratory educators and adults with COPD who kindly volunteered their time to participate in the present study.
MG, SL, CH, JB, JM, and LPB contributed to the study design. MG, JBT, and SEP participated in participant recruitment and/or data collection. MG conducted statistical analyses and participated, along with CH, to qualitative analyses. All authors contributed to data interpretation. M.G. wrote the initial draft and SL, CH, JBT, SEP, JB, JM, and LPB revised it for important intellectual content. All authors have given final approval of the version to be published. MG and LPB have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with Ethical Standards
The Laval University Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health funded the study. For the development and deployment of the training, the Université Laval Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health received funding from the GlaxoSmithKline Medical Education Support Program (the program funds were not used in connection with the research). As part of her doctoral studies, Myriam Gagné received a scholarship from the Fonds de recherche du Québec – Santé to conduct the present study.
Conflict of interest
The authors alone are responsible for the content and writing of this paper. The Université Laval Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health is supported by unrestricted grants from AstraZeneca. The Chair has received funding from GlaxoSmithKline for the development and deployment of the educational component. The program funds were not used in connection with the research. The funding body had no role in the study design, collection, analysis, or interpretation of the data. The publication of our study results will not be contingent on our sponsor’s approval or censorship of the manuscript. The Québec Respiratory Health Education Network is supported by unrestricted grants from AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, and Novartis. Myriam Gagné, Sophie Lauzier, Justine Babineau-Therrien, Christine Hamel, Sara-Edith Penney, Jean Bourbeau, and Jocelyne Moisan have no conflicts of interest that are directly relevant to the content of this article. Louis-Philippe Boulet declares the following potential conflicts of interest—last 3 years: Research grants for participation to multicenter studies: AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi, Takeda. Support for research projects introduced by the investigator: AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Takeda. Consulting and advisory boards: Astra Zeneca, Novartis, Methapharm. Royalties: Co-author of “Up-To-Date” (occupational asthma). Non-profit grants for production of educational materials: AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis. Conference fees: AstraZeneca, GlaxoSmithKline, Merck, Novartis. Support for participation in conferences and meetings: Novartis, Takeda.
The trial has been approved by the Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval Ethics Committee (Approval number: MP-10-2016-2591).
Informed consent was obtained from all participants included in the study.
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