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， 其特征在于通常需要住院治疗的恶化。吸入药物，如 长效支气管扩张剂和吸入性皮质类固醇可减少COPD急性加重， 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），已显着减少吸入器滥用， 通过提供吸入器， 教育在退伍军人的家，并允许它随着时间的推移重复。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 项目，以改善COPD患者的吸入器技术，和2）检查“教- 通过CVT到家庭提供的“目标”吸入器培训，内容涉及吸入器技术、药物 COPD患者的依从性和呼吸道症状。 将邀请VA Puget Sound医疗保健系统的COPD患者参加。 合格标准包括：1）COPD的临床诊断，2）至少一种VA处方COPD 吸入器，3）每周至少使用一次吸入器，4）无明显精神并发症，以及 5)可以使用电脑和高速互联网。入组患者将与VA一起工作 普吉湾远程保健技术人员设置网络摄像机，安装和测试 远程医疗软件患者将通过邮件填写问卷，以确定COPD疾病 严重程度和自我效能，健康素养，以及干预前后的生活质量。 在四次CVT家访过程中，接受过TTG方法培训的临床护士将 向患者提供吸入器使用说明，并观察患者对每个COPD吸入器的使用情况。 为了评估干预的可行性（目标1），我们将评估患者的比例 有兴趣参与干预的人。入学人数 患者，我们将衡量未显示率和访问的比例与技术 限制干预措施实施的问题。我们将通过管理 一个适应VISN 20 CVT到家庭满意度调查。检查TTG吸入器的效果 通过CVT到家（目标2）提供的培训，我们将对正确使用吸入器的患者进行评分， 确定最终访视时评分是否改善。吸入器药物的再填充依从性， 将干预措施与家庭CVT吸入器培训后的依从性进行比较 干预干预前后的呼吸道症状将使用 COPD评估测试。 利用VHA的CVT到家庭计划提供吸入器培训是一种很有前途的手段， 帮助退伍军人提供急需的药物教育。本研究的数据将 通知一个更大的干预试验，重点是减少急诊室的访问， 因COPD急性加重住院治疗。

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.