Video-to-Home Inhaler Training Program for Chronic Obstructive Pulmonary Disease

慢性阻塞性肺疾病(COPD)在退伍军人中很常见，而且 以病情恶化为特征的，通常需要住院治疗。吸入药物，如 长效支气管扩张剂和吸入皮质类固醇可以减少COPD的恶化和 与COPD相关的住院治疗。然而，80%的COPD患者不正确地使用吸入器， 这可能导致更严重的症状和更多的住院治疗。吸入器培训 计划，“教学目标”(TTG)，已显著减少吸入器滥用，并可能 通过提供吸入器，符合VHA新的临床视频远程医疗(CVT)到户计划 在退伍军人家中接受教育，并允许随着时间的推移重复这一过程。该提案旨在 目的：1)确定CVT到家庭患者教育的可行性、可接受性和安全性 改善慢性阻塞性肺疾病患者吸入器技术的计划；2)检查“教-教”的效果。 通过CVT-to-Home提供的关于吸入器技术、药物的“目标”吸入器培训 慢性阻塞性肺疾病患者的依从性和呼吸道症状。 VA Puget Sound医疗保健系统的COPD患者将被邀请参加。 资格标准包括：1)COPD的临床诊断；2)至少一种VA处方的COPD 吸入器，3)每周至少使用一次吸入器，4)没有明显的精神合并症，以及 5)可以使用电脑和高速互联网。登记的患者将与退伍军人管理局合作 Puget Sound远程医疗技术人员设置网络摄像机并安装和测试 远程医疗软件。患者将通过邮寄方式填写调查问卷，以确定COPD疾病 干预前后的严肃性和自我效能感、健康素养、生活质量。 在四次CVT到家访问的过程中，一名经过TTG方法学培训的临床护士将 向患者提供吸入器说明，并观察患者使用每个COPD吸入器的情况。 为了评估干预的可行性(目标1)，我们将评估患者的比例 有高速互联网的有兴趣参与干预的人。在录取的学生中 我们将测量患者的缺勤率和就诊比例 限制干预交付的问题。我们将通过以下方式来衡量可接受性 改编的VISN20 CVT到家满意度调查。检查TTG吸入器的效果 通过CVT-to-Home提供的培训(目标2)我们将对患者正确使用吸入器进行评分 确定最后一次访问是否提高了分数。吸入器药物再灌装之前的粘连 干预将被比作在CVT到家庭吸入器培训之后的坚持 干预。干预前后的呼吸道症状将使用 慢性阻塞性肺疾病评估测试。 利用VHA的CVT到家庭计划来提供吸入器培训是一种有希望的方法 帮助退伍军人提供急需的药物教育。这项研究的数据将 告知更大规模的干预试验，重点是减少急诊科就诊次数和 因慢性阻塞性肺疾病加重而住院。

Chronic obstructive pulmonary disease (COPD) is common among Veterans, and is characterized by exacerbations that often require hospitalization. Inhaled medications such as long-acting bronchodilators and inhaled corticosteroids can reduce COPD exacerbations and related COPD hospitalizations. However, 80% of COPD patients use their inhalers incorrectly, which may lead to worse symptoms and increased hospitalizations. An inhaler training program, "Teaching-to-goal" (TTG), has significantly decreased inhaler misuse, and may be amenable to VHA's new Clinical Video Telehealth (CVT)-to-Home program by providing inhaler education at the Veteran's home and allowing it to be repeated over time. The proposal aims to: 1) determine the feasibility, acceptability, and safety of a CVT-to-Home patient education program to improve inhaler technique in COPD patients, and 2) to examine the effect of "Teach- to-Goal" inhaler training delivered via a CVT-to-Home on inhaler technique, medication adherence and respiratory symptoms in COPD. COPD patients at the VA Puget Sound Health Care System will be invited to participate. Eligibility criteria include: 1) clinical diagnosis of COPD, 2) at least one VA prescribed COPD inhaler, 3) use inhaler at least once a week, 4) lack of a significant psychiatric comorbidity, and 5) have access to a computer and high-speed internet. Enrolled patients will work with a VA Puget Sound telehealth technician to set up a web video camera and install and test the telehealth software. Patients will complete questionnaires by mail to ascertain COPD disease severity and self-efficacy, health literacy, and quality of life before and after the intervention. Over the course of four CVT-to-home visits a clinical nurse trained in the TTG methodology will provide inhaler instructions to the patient and observe the patient's use of each COPD inhaler. To assess the feasibility of the intervention (aim 1) we will assess the proportion of patients with high-speed internet who are interested in participating in the intervention. Among enrolled patients we will measure the rate of no-shows and the proportion of visits with technological issues limiting the delivery of the intervention. We will measure acceptability by administering an adapted VISN20 CVT-to-home satisfaction survey. To examine the effect of the TTG inhaler training delivered via CVT-to-Home (aim 2) we will score patients in correct inhaler use to determine if scores improved by the final visit. Refill adherence of inhaler medications before the intervention will be compared to adherence following the CVT-to-Home inhaler training intervention. Pre- and post-intervention respiratory symptoms will be compared using the COPD Assessment Test. Utilizing VHA's CVT-to-Home program to deliver inhaler training is a promising means to reaching Veterans to provide much needed medication education. Data from this study will inform a larger intervention trial focused on reducing emergency department visits and hospitalization for COPD exacerbations.