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）： 及时使用口服类固醇和/或抗生素治疗慢性阻塞性肺病 (COPD) 急性加重，最好是在症状出现后 3 天内进行治疗，可以降低急性加重的严重程度和持续时间，并可能降低慢性阻塞性肺病 (COPD) 住院治疗的风险，这是早期实现这一目标的一种方法。治疗方法是使用支持性自我管理计划，其中包括带有类固醇和/或抗生素家庭处方的行动计划。然而，最近的研究表明，支持性自我管理计划可能不适合大多数慢性阻塞性肺病患者。因此，需要一种不依赖于患者自我管理的新方法，这项研究将检查退伍军人的寻求护理行为，重点关注退伍军人对护理的感知需求和获得护理的方式。这些因素延迟了慢性阻塞性肺病急性加重的寻求治疗，增加了住院的风险。这项研究还将评估一种通过使用远程吸入器监测系统来识别早期急性加重的新方法。关于影响患者决定何时住院的因素的数据很少。寻求护理。根据所需数据，本研究将招募 410 名患有慢性阻塞性肺病 (COPD) 急性加重风险的退伍军人，并对每位患者进行为期一年的跟踪。具体目标是： 1) 检查因慢性阻塞性肺病 (COPD) 加重或呼吸恶化而寻求治疗的障碍；2) ) 测试使用实时远程吸入器监测器来识别早期病情加重情况，VA Puget Sound 和 VA Eastern Colorado 的 410 名参与者将参加这项研究。如图 1a 和 1b 所示，约 60 名报告 COPD 恶化且已住院、作为门诊患者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，以了解他们对病情恶化的反应并决定是否寻求护理（如有），这些退伍军人的护理人员将接受采访，以了解他们对情况的看法。 在目标 1c 中，参与者将参加一次面对面的基线访视，以完成肺活量测定和基线调查问卷，为期 1 年，使用交互式语音应答系统，该系统将筛查 COPD 恶化（4 个是/否）。筛查结果呈阳性的参与者将被研究人员召回，以获取有关病情恶化及其治疗方式的更多详细信息。数据分析将检查哪些地方可以获得护理和基线因素与治疗延迟有关。目标 2 中，来自目标 1 的 200 名参与者将使用带有沙丁胺醇吸入器的吸入器监测器，该监测器将实时传输有关其日常吸入器使用情况的数据。他们将在 12 个月的随访期间使用该监测器。衡量沙丁胺醇使用变化的能力，以预测患者报告的慢性阻塞性肺病恶化，以确定可用于未来干预试验的适当截止值。这些目标将为如何最好地提供关键的详细信息。进行干预，确保在不依赖自我管理的情况下及时识别和治疗慢性阻塞性肺病恶化。新的医疗保健提供方法将帮助退伍军人及早识别恶化，并提供可纳入退伍军人管理局初级护理、急诊医学和肺部护理的早期护理服务。特殊护理设置。