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.

慢性阻塞性肺疾病（COPD）在退伍军人中很常见，IS 其特征是经常需要住院的加重。吸入药物，例如 长效支气管扩张剂和吸入的皮质类固醇可以减少COPD加剧，并 相关的COPD住院。但是，有80％的COPD患者错误地使用吸入器， 这可能导致症状更严重并增加了住院治疗。吸入器培训 计划“教学到目标”（TTG）已大大减少吸入器滥用，可能是 可以通过提供吸入器来适应VHA的新临床视频远程医疗（CVT）到家庭计划 在退伍军人的家中进行教育，并随着时间的流逝而重复。该提议的目的 至：1）确定CVT - 家庭教育的可行性，可接受性和安全性 改善COPD患者吸入技术的计划，以及2）检查“教学的效果 通过CVT-to-to-to-to-to-to-goal“吸入器培训 COPD中的依从性和呼吸道症状。 VA Puget Sound医疗保健系统中的COPD患者将被邀请参加。 资格标准包括：1）COPD的临床诊断，2）至少一个VA规定的COPD 吸入器，3）每周至少使用一次吸入器，4）缺乏重大的精神病合并症和 5）可以访问计算机和高速互联网。入学的患者将与VA一起工作 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。患者将通过邮件填写调查表以确定COPD病 干预之前和之后的严重性和自我效能，健康素养以及生活质量。 在四个CVT到家庭的访问中，接受TTG方法训练的临床护士将 向患者提供吸入器说明，并观察患者使用每个COPD吸入器。 为了评估干预的可行性（AIM 1），我们将评估患者的比例 有兴趣参加干预的高速互联网。在注册中 患者我们将测量未出现的速度和技术的访问比例 限制干预措施提供的问题。我们将通过管理来衡量可接受性 适应的VISN20 CVT到家庭满意度调查。检查TTG吸入器的效果 通过CVT-TO-HOME提供的培训（AIM 2）我们将以正确的吸入器的使用率为患者评分 确定最终访问是否提高了分数。补充吸入药物之前的依从性 将干预措施与CVT到回家吸入器培训后的依从性进行比较 干涉。使用前后干预前后的呼吸道症状将使用 COPD评估测试。 利用VHA的CVT到家计划提供吸入器培训是一种有希望的手段 接触退伍军人提供急需的药物教育。这项研究的数据将 通知更大的干预试验，重点是减少急诊室就诊和 COPD加重的住院。