Implementation evaluation of the „Living well with COPD” self-management program in Switzerland

Abstract

Introduction: Self-management can improve health status and reduce hospital admissions in COPD patients. Aims and Objectives: The aim of this mixed-methods study was to evaluate the implementation of the “Living well with COPD” self-management program, a nation-wide effort by Swiss Lung Associations. Methods: For the implementation evaluation we used qualitative (interviews, focus groups) and quantitative (questionnaires, documentation analysis) methods to assess indicators of the outcomes reach, dose, fidelity, acceptability and appropriateness. To evaluate effectiveness, we assessed disease specific quality of life, symptoms, exercise capacity, health care utilisation and health behaviour at baseline and the end of the program (after 14 months). Results: 7 Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients (mean age 69 years, 48% female). Patients’ attendance rate and coaches’ fidelity to protocol were high (81% and 94%). Overall, acceptance and satisfaction of all involved persons was very high. Challenges were sustainable funding, integration of the coaches’ additional workload and uncertainties regarding roles and responsibilities. After 14 month, the patients did not just avoid a decline in health status but improved in 3 of 4 Chronic Respiratory Questionnaire subscales (0.2-0.4 units) and the 1-minute sit-to-stand test (23.9 vs. 27.1 repetitions). Conclusions: The “Living well with COPD” program was successfully implemented and showed a remarkably positive impact. The insights of this study serves the international community since it is one of the first nation-wide implementations beyond study settings.