Lecture 5 COPD course Self management of COPD


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COPD Course : organized by ECI

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Lecture 5 COPD course Self management of COPD

  1. 1. COPD Self-Management
  2. 2. Readmissions:According to Medicare discharge claims, COPDis listed in the top 3 for readmission within 30days of discharge.
  3. 3. Looking Closer:Readmission rates 30% in African AmericanpopulationLow income accounts for 22% higherreadmission rateCost is higher for readmission than for initialstayAgency for healthcare, research and quality statistical brief #121, Sept 2011
  4. 4. What influences Adherence?Medication CharacteristicsPatient VariablesClinician Factors
  5. 5. What about Adherence:According to WHO:"The extent to which a persons behavior takingmedications, following a diet, and or executinglifestyle changes correspond with agreerecommendations from a health care provider"
  6. 6. Types of Non Adherence: Erratic non-adherence: Patient understandsand agrees on plan but has difficultymaintaining regimen Unwitting non-adherence: Both patient andclinician mistakenly believe patient is adherent Intelligent non-adherence: Patient deliberatelyalters or changes therapy based on reasoneddecision making
  7. 7. Poor Adherence According toWHO: >50% of patients have poor adherence indeveloped countries Impact grows as prevalence grows Use patient tailored intervention Need to train health care workers to optimizeadherence Multidisciplinary approach is needed
  8. 8. Non Adherence:In the United States, non adherence to medicalregimens has been estimated to cost the UShealth-care system $100 billion per year. Overall,therefore, the outcome of non adherence is loss:loss of opportunities for patients to improve theirhealth, and loss of medication by health-caresystems, with the subsequent effect of increasedmorbidityHorne, R Concordance and medicines management In the respiratory arena.2003,Hayward Medical Publications
  9. 9. What about the patients?Survey 1230 peds and 604 adults▫ 58-79 reported side effects▫ Most reported to MD▫ Patient response was to skip treatment (25% ),adjust dose (33%)▫ MD more likely to alter adult dose vs pedsWhite et al, J Allergy Clin Immunol;l, Aug 99
  10. 10. Adherence: Generally poor Peds: Under use 55% of time (electronicmonitor MD I) Coutts et al, Arch Dis Child, Morch,1992 73% reported use but only 15% actually did andin same study 14% have >100 actuations 3 hoursbefore clinic.Rand at al , Am Rev Respir Dis, june 1992
  11. 11. Medication Characteristics: Taste Schedule Side Effects Expense Delivery Method Multiple Doses/Medications Prescribed Duration of Medication
  12. 12. Common MDI Errors:Failure to coordinate actuation with Inhalation(27%) Short or no breath-hold after inspiration (26%) Too rapid an inspiratory flow rate (19%) Inadequate shaking prior to use (13%) Stopping inspiration when aerosol hits throat(6%) Firing MDI multiple times during inspiration Placing wrong end of inhaler in mouth, holdingupside down, or failure to take cap off
  13. 13. Improper Use of DeliveryDevices: MDI and Diskus competence very poor in hospitalizedpatients 86% MDI and 71% Diskus misuse More likely to misuse if vision impairment or healthliteracy is low Patients required at least 2 sessions to master technique Results suggest that adequate hospital instruction canovercome these barners to serf-management Educate, patient demonstration, critique technique,reeducate (if necessary)
  14. 14. Improper Use of Delivery Devices(cont):Results suggest that adequate hospitalinstruction can overcome these barners to self-management Educate, patient demonstration.V.G. Press et al, J Gen Intern Med, Jan 2011
  15. 15. Patient Drug Information: 366 adult patients surveyed upon exitingpharmacy 30% of patients indicated that they did notknow the purpose of at least one of their drugs 69% said they needed more information Patients rely on package inserts (36%) Patients with limited education required moreinformation
  16. 16. Patient Variable than can ImpedeSelf-Management Misperception of Attack Severity Failure to Obtain Medication D/C due to Side Effects Beliefs and Expectations Social Stigma/support Income Family composition/dynamics Memory Loss Low Literacy
  17. 17. Self-Management Barries. Poor health literacy Poor audiovisual capabilities Inadequate physical capabilities Low cognitive capacity
  18. 18. Self-Management: Self Management education for COPD doesdecrease hospital admissions/EO visits Inconclusive effect on▫ Exacerbations▫ Lung function▫ Missed days from work▫ Physician visits
  19. 19. Self-Management Study:Multi-center Patients> 50 years Stable COPD Symptoms under con trol▫ Randomized: Control -usual management Study- usual management and enhanced educationArch Inter Med. Bourbeau J. at al, 2003
  20. 20. Self-Management: Study group had one hour per week of hometeaching (8 weeks). Weekly phone follow-up. RT or RN available to patients by phone PRNArch Inter Med. Bourbeau J. at al, 2003
  21. 21. Self-Management: Workbooks Action Plans Healthy Lifestyle Suggestions Home exercise Program Traveling with Oxygen Inhalation techniquesArch Inter Med. Bourbeau J. at al, 2003
  22. 22. Self-Management: COPD▫ Home visitation by health care professionalresulted in: Reduced admissions 40% ED visits reduced by 41% Unplanned PCP visits by 59% Reduction in admjssions for non pulmonaryproblems by 57%Arch Inter Med. Bourbeau J. at al, 2003
  23. 23. Action Plans for COPD:Have been shown to reduce morbidity anmortality (Bourbeau J, et al. Chest. 2006;130(6):1704-11)
  24. 24. What Should be in a COPD ActionPlan? Medications (dose, route of delivery, &..frequency) Best FEV1 (if known) Best FVC (if known) Room air oxygen saturation Oxygen setting (frequency and dose)
  25. 25. Action Plan:Symptoms and recommended responsesContact information (physician, emergencycontact, nearest hospital)Comorbidities
  26. 26. Action Plan:Some action plans also include general heathcare information such as▫ Vaccine history▫ Smoking status (and if still a smoker the plan forsmoking cessation▫ Exercise plan▫ Diet plan
  27. 27. Conclusion:Understand the patients educational need.Teach to that need and follow up.