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

慢性阻塞性肺疾病视频到家吸入器培训计划

• 批准号: 8676388
• 负责人: Vincent S Fan
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676388
• 关键词: Accident and Emergency department; Adherence; Admission activity; Adrenal Cortex Hormones; Affect; Breathing; Bronchodilator Agents; Chronic; Chronic Obstructive Airway Disease; Clinic Visits; Clinical; Clinical Nursing; Clinical Trials; Comorbidity; Computer software; Computers; Data; Devices; Diabetes Mellitus; Education; Educational Intervention; Educational process of instructing; Eligibility Determination; Enrollment; Feasibility Studies; Goals; Guidelines; Healthcare Systems; Home environment; Home visitation; Hospitalization; Hospitals; House Call; Inhalators; Inpatients; Instruction; Internet; Intervention; Intervention Trial; Knowledge; Lead; Lung; Mails; Measures; Methodology; Methods; Nurses; Online Systems; Oral; Outcome; Patient Education; Patients; Pharmaceutical Preparations; Pharmacists; Process; Provider; Quality of life; Questionnaires; Reading; Risk; Safety; Self Efficacy; Severity of illness; Speed; Surveys; Symptoms; Tablets; Techniques; Technology; Teenagers; Telephone; Testing; Time; Training; Training Programs; Travel; Veterans; Visit; Work; capsule; clinical Diagnosis; health care service utilization; health literacy; improved; interest; medication compliance; mortality; novel; outcome forecast; pill; post intervention; prevent; programs; respiratory; satisfaction; skills; sound; telehealth

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.

慢性阻塞性肺病（COPD）在退伍军人中很常见，并且 其特点是病情恶化，通常需要住院治疗。吸入药物，例如 长效支气管扩张剂和吸入皮质类固醇可以减少慢性阻塞性肺病（COPD）的恶化 相关的慢性阻塞性肺病住院治疗。然而，80% 的慢性阻塞性肺病患者使用吸入器的方式不正确， 这可能会导致更严重的症状和增加住院治疗。吸入器训练 “目标教学”（TTG）计划显着减少了吸入器的误用，并且可能 通过提供吸入器来适应 VHA 新的临床视频远程医疗 (CVT) 到家计划 在退伍军人之家进行教育，并允许随着时间的推移重复进行。该提案的目的 目的：1) 确定 CVT 到家患者教育的可行性、可接受性和安全性 改善 COPD 患者吸入器技术的计划，以及 2) 检查“Teach- 通过 CVT-to-Home 提供有关吸入器技术、药物治疗的“to-Goal”吸入器培训 COPD 的依从性和呼吸道症状。 VA Puget Sound 医疗保健系统的慢性阻塞性肺病患者将受邀参加。 资格标准包括：1) 临床诊断为慢性阻塞性肺病，2) 至少有一项 VA 处方慢性阻塞性肺病 吸入器，3) 每周至少使用一次吸入器，4) 没有显着的精神合并症，以及 5）可以使用计算机和高速互联网。登记的患者将与 VA 一起工作 普吉特湾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。患者将通过邮寄填写问卷来确定慢性阻塞性肺病 干预前后的严重程度和自我效能、健康素养以及生活质量。 在四次 CVT 上门拜访过程中，经过 TTG 方法培训的临床护士将 向患者提供吸入器说明并观察患者对每种慢性阻塞性肺病吸入器的使用情况。 为了评估干预措施的可行性（目标 1），我们将评估患者的比例 有高速互联网、有兴趣参与干预的人。注册人数中 我们将通过技术衡量患者的缺席率和就诊比例 限制干预实施的问题。我们将通过管理来衡量可接受性 一项改编后的 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 确定最终访问时分数是否有所提高。之前补充吸入药物的依从性 该干预措施将与 CVT-to-Home 吸入器培训后的依从性进行比较 干涉。将使用以下方法比较干预前和干预后的呼吸道症状 慢性阻塞性肺病评估测试。 利用 VHA 的 CVT-to-Home 计划提供吸入器培训是一种很有前途的方法 向退伍军人提供急需的药物教育。这项研究的数据将 为更大规模的干预试验提供信息，重点是减少急诊室就诊次数和 因 COPD 恶化而住院。