Understanding Patient Management of COPD Exacerbations

了解 COPD 急性加重的患者管理

• 批准号: 9894748
• 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: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894748
• 关键词: Accident and Emergency department; Affect; Albuterol; Antibiotics; Appointment; Back; Behavior; Breathing; Caregivers; Caring; Case Manager; Cause of Death; Chronic Care; Chronic Obstructive Airway Disease; Cognitive; Colorado; Comorbidity; Coughing; Data; Data Analyses; Early identification; Early treatment; Emergency Medicine; Emergency department visit; Emotional; Enrollment; Ensure; Evaluation; Event; Future; Goals; Health Services Accessibility; Home environment; Hospitalization; Hour; Inhalators; Intervention; Intervention Trial; Interview; Lead; Lung; Measures; Medical; Medical Care Team; Mental disorders; Methods; Modeling; Monitor; Oral; Outcome; Outpatients; Participant; Patient Care; Patients; Persons; Prednisone; Primary Health Care; Prospective cohort; Prospective cohort study; Questionnaires; Reporting; Research; Research Training; Respiratory Signs and Symptoms; Risk; Sampling; Self Management; Severities; Shortness of Breath; Social support; Spirometry; Sputum; Steroids; Structure; Symptoms; System; Telephone; Testing; Time; Transportation; Veterans; Visit; Voice; Work; asthma inhaler; base; care seeking; cohort; contextual factors; follow-up; health care delivery; high risk; hospitalization rates; medical specialties; mild cognitive impairment; mortality; novel; novel strategies; prevent; response; self-management program; sound; stem; therapy development

 DESCRIPTION (provided by applicant): Prompt treatment of chronic obstructive pulmonary disease (COPD) exacerbations with oral steroids and/or antibiotics, ideally within 3 days of onset of symptoms, can decrease the severity and duration of exacerbations and may reduce the risk of COPD hospitalizations. One approach to accomplishing early treatment is to use a supported self-management program that includes an action plan with a home prescription for steroids and/or antibiotics. However, recent studies suggest that supported self-management programs may not be appropriate for the majority of COPD patients, and may in fact be harmful. Therefore, a new approach is needed that does not rely on patient self-management. This study will examine Veterans' care-seeking behaviors focusing on Veterans perceived need for care and perceived access to care and how these factors delay seeking care for COPD exacerbations, increasing the risk for hospitalizations. This study will also evaluate one novel approach of identifying early exacerbations through the use of a remote inhaler monitoring system. There is little data on the factors that influence when patients decide to seek care. To obtain this needed data, this study will enroll a cohort of 410 Veterans with COPD at high-risk for exacerbations and follow every patient for 1 year. The Specific Aims are: 1) Examine the barriers to seeking care for COPD exacerbations or worsening breathing; 2) Test the use of a real-time remote inhaler monitor to identify early exacerbations. 410 participants at VA Puget Sound and the VA Eastern Colorado will be enrolled in the study. For Aim 1a and 1b, approximately 60 participants who reported a COPD exacerbation and were either hospitalized, treated as outpatients, or did not seek treatment will participate in an in-depth semi-structured interview by a trained research staff to understand how they responded to their worsening symptoms and decided whether to seek care. When available, the caregivers for these Veterans will be interviewed to obtain their perspective on the exacerbation event. In Aim 1c, participants will attend one in-person baseline visit to complete spirometry and baseline questionnaires. Participants will be contacted every 2 weeks for 1 year using an interactive voice response system that will screen for COPD exacerbations with 4 yes/no questions. Participants with a positive screen will be called back by research staff to obtain additional detailed information on the exacerbation and how it was treated. Data analysis will examine where access to care and baseline factors are associated with a delay in treatment. In Aim 2, 200 participants from Aim 1 will use an inhaler monitor with their albuterol inhaler, which will transmit data in real-time about their daily inhaler use. They will use this monitor for the 12-month follow-up period. Data analysis will measure ability of a change in albuterol use to predict patient reported COPD exacerbations to determine the appropriate cut-offs that can be used in a future intervention trial. These aims will provide critical detailed information on how best to intervene to ensure prompt identification and treatment of COPD exacerbations without relying on self-management. New health care delivery approaches will assist Veterans in early identification of exacerbations and provide early access to care that can be integrated into the VA primary care, emergency medicine and pulmonary specialty care settings.

 描述（由申请人提供）： 及时口服类固醇和/或抗生素治疗慢性阻塞性肺疾病（COPD）急性加重，理想情况下在症状发作后3天内，可以降低急性加重的严重程度和持续时间，并可能降低COPD住院的风险。完成早期治疗的一种方法是使用支持的自我管理计划，其中包括类固醇和/或抗生素的家庭处方的行动计划。然而，最近的研究表明，支持自我管理计划可能不适合大多数COPD患者，实际上可能是有害的。因此，需要一种不依赖于患者自我管理的新方法。 本研究将检查退伍军人的求医行为，重点是退伍军人对护理的感知需求和感知获得护理的机会，以及这些因素如何延迟寻求COPD急性加重的护理，增加住院治疗的风险。本研究还将评估一种通过使用远程吸入器监测系统识别早期急性加重的新方法。 关于影响患者决定何时寻求护理的因素的数据很少。为了获得所需的数据，本研究将招募410名COPD急性加重高风险退伍军人，并对每位患者进行1年随访。具体目标是：1）检查COPD急性加重或呼吸恶化寻求护理的障碍; 2）测试使用实时远程吸入器监测器来识别早期急性加重。 本研究将入组VA普吉特湾和VA东部科罗拉多的410名受试者。对于目标1a和1b，大约60名报告COPD急性发作并住院、门诊治疗或未寻求治疗的参与者将参加由训练有素的研究人员进行的深入半结构化访谈，以了解他们如何应对恶化的症状并决定是否寻求治疗。如果可行，这些退伍军人的照顾者将接受采访，以了解他们对 急性加重事件。 在目标1c中，受试者将参加一次面对面基线访视，以完成肺功能测定和基线问卷调查。将使用交互式语音应答系统每2周一次联系受试者，持续1年，该系统将通过4个是/否问题筛选COPD急性加重。筛查结果为阳性的受试者将被研究人员召回，以获得有关急性加重及其治疗方式的更多详细信息。数据分析将检查获得护理和基线因素与治疗延迟相关的情况。 在目标2中，来自目标1的200名参与者将使用沙丁胺醇吸入器监测器，该监测器将实时传输有关其每日吸入器使用情况的数据。他们将在12个月随访期内使用该监护仪。数据分析将测量沙丁胺醇使用变化预测患者报告的COPD急性加重的能力，以确定可用于未来干预试验的适当临界值。 这些目标将提供关于如何最好地干预以确保在不依赖自我管理的情况下及时识别和治疗COPD急性加重的关键详细信息。新的医疗保健提供方法将有助于退伍军人早期识别病情加重，并提供抢先体验，以照顾可以整合到VA初级保健，急诊医学和肺部专科护理设置。