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

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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.