Abstract
BackgroundSelf‐management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory‐related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital.AimThis pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3‐month follow‐up.MethodsThe study was carried out in a randomised controlled design with follow‐up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD‐related readmissions was measured as the primary outcome.ResultsCompared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS‐depression, but none in HADS‐anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy.ConclusionsA personally tailored action plan introduced at or postdischarge combined with follow‐up support is an effective self‐management tool to support recovery and to reduce unnecessary readmissions. In future follow‐up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.
Highlights
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable condition characterised by dyspnoea, fixed airflow limitation, and is most often caused by increased airway inflammatory response to particle/ gas exposure [1]
In the current pilot study, we demonstrated that a personalised action plan (AP) provided at or postdischarge after an admission for acute exacerbations of COPD (AECOPD) is feasible and significantly reduced number of readmissions in the following months
Valuable information could be obtained by future studies on patients’ perception of AP including those patients who do not happily accept the AP invitation but refuse of one reason or another. This pilot study has shown that a personalised written AP provided at or postdischarge after an admission for AECOPD, and based on a person-centred self-management approach, is able to reduce the number of readmissions significantly in the following three months
Summary
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable condition characterised by dyspnoea, fixed airflow limitation, and is most often caused by increased airway inflammatory response to particle/ gas exposure [1]. Repeated admissions for AECOPD are associated with anxiety and depression, reduced quality of life, loss of functions of daily living and an even higher risk of mortality [2,6]. Many initiatives have been implemented to improve quality of health care in recent years, reducing readmissions for AECOPD remains a problem that might require solutions that ensure a comprehensive and personalised prevention strategy for the individual COPD patient [4,10]. Self-management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory-related hospitalisations. Aim: This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3-month follow-up.
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