Activating primary care COPD patients with multi-morbidity (APCOM) pilot project: Study protocol

Sameera Ansari, Hassan Hosseinzadeh, Sarah Dennis, Nicholas Zwar

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Abstract

Chronic obstructive pulmonary disease (COPD), third leading cause of mortality worldwide,1 is primarily caused by cigarette smoking in Australia.2 COPD often occurs in the presence of multi-morbidity, which is the simultaneous occurrence of two or more chronic conditions; this is a growing concern in a health system focused on single-disease management.3 Around 80% of older Australians have multi-morbidity, average prevalence of chronic respiratory disease being 9.5%.4 A systematic review of COPD education programs suggests that equipping patients with self-management skills is as important as disease knowledge.5 Studies exploring positive effects of chronic disease-management interventions6 also underline the lack of studies aimed at empowering patients. Although a recent Cochrane Review7 of COPD self-management interventions shows increased health-related quality of life and decreased probability of respiratory-related hospitalisation, similar interventions have not been consistently effective when applied in recent trials.8-10 Though interventions aimed at modifying COPD-related health behaviour have great potential, extant literature points to need for self-management programs in primary care. There is a dearth of interventions involving patients with multimorbidity, clinicians and other stakeholders, that can be generalisable to other populations.11 Patients with multimorbidity are often excluded from chronic disease-management trials; a Cochrane review12 of multi-morbidity interventions found only ten such studies. Our recent qualitative study,13 which explored the impact of COPD diagnosis in primary care patients with co-morbidities (co-existing chronic conditions), found suboptimal disease understanding and health-care utilisation. The above evidence demonstrates a need for development and testing interventions to increase self-management capacity in COPD patients with co-morbidities. Even a brief education session is effective in improving disease knowledge and response to symptoms;14 as demonstrated by selfmanagement interventions10, 15 on COPD which increased patient self-efficacy. Such programs do not only improve health status and prevent hospital remissions,16 but also lead to better patientprovider relationships, self-efficacy and sense of identity.17 With no prior study having seemed to focus on improving self-efficacy of COPD patients with co-morbidities in primary care, our study aims to empower these patients by trialling a tailored, practice nurse -delivered self-management program. AIMS This pre and post-test pilot study aims to trial the impact and feasibility of a tailored self-management program for primary care COPD patients with multi-morbidity. Our hypothesis is that at six months' follow-up, participants would have: 1. Better activation in terms of their COPD-related health behaviour. 2. Improved knowledge and self-management capacity of COPD. 3. Increased self-efficacy in terms of their overall health behaviours. METHODS This pilot study is funded by GlaxoSmithKline Australia and recognised by the National Health and Medical Research Council through a scholarship to S.A. The study has approval from the Human Research Ethics Committee of UNSW Australia (HREC14139).

Original languageEnglish
Article number41533
Journalnpj Primary Care Respiratory Medicine
Volume27
Issue number1
DOIs
Publication statusPublished - 16 Feb 2017
Externally publishedYes

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Morbidity
Self Care
Self Efficacy
Health Behavior
Disease Management
Chronic Disease
Comorbidity
Patient Acceptance of Health Care
Knowledge Management
Education
Research Ethics Committees
Health
Health Status
Biomedical Research
Hospitalization
Smoking
Nurses
Quality of Life

Cite this

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title = "Activating primary care COPD patients with multi-morbidity (APCOM) pilot project: Study protocol",
abstract = "Chronic obstructive pulmonary disease (COPD), third leading cause of mortality worldwide,1 is primarily caused by cigarette smoking in Australia.2 COPD often occurs in the presence of multi-morbidity, which is the simultaneous occurrence of two or more chronic conditions; this is a growing concern in a health system focused on single-disease management.3 Around 80{\%} of older Australians have multi-morbidity, average prevalence of chronic respiratory disease being 9.5{\%}.4 A systematic review of COPD education programs suggests that equipping patients with self-management skills is as important as disease knowledge.5 Studies exploring positive effects of chronic disease-management interventions6 also underline the lack of studies aimed at empowering patients. Although a recent Cochrane Review7 of COPD self-management interventions shows increased health-related quality of life and decreased probability of respiratory-related hospitalisation, similar interventions have not been consistently effective when applied in recent trials.8-10 Though interventions aimed at modifying COPD-related health behaviour have great potential, extant literature points to need for self-management programs in primary care. There is a dearth of interventions involving patients with multimorbidity, clinicians and other stakeholders, that can be generalisable to other populations.11 Patients with multimorbidity are often excluded from chronic disease-management trials; a Cochrane review12 of multi-morbidity interventions found only ten such studies. Our recent qualitative study,13 which explored the impact of COPD diagnosis in primary care patients with co-morbidities (co-existing chronic conditions), found suboptimal disease understanding and health-care utilisation. The above evidence demonstrates a need for development and testing interventions to increase self-management capacity in COPD patients with co-morbidities. Even a brief education session is effective in improving disease knowledge and response to symptoms;14 as demonstrated by selfmanagement interventions10, 15 on COPD which increased patient self-efficacy. Such programs do not only improve health status and prevent hospital remissions,16 but also lead to better patientprovider relationships, self-efficacy and sense of identity.17 With no prior study having seemed to focus on improving self-efficacy of COPD patients with co-morbidities in primary care, our study aims to empower these patients by trialling a tailored, practice nurse -delivered self-management program. AIMS This pre and post-test pilot study aims to trial the impact and feasibility of a tailored self-management program for primary care COPD patients with multi-morbidity. Our hypothesis is that at six months' follow-up, participants would have: 1. Better activation in terms of their COPD-related health behaviour. 2. Improved knowledge and self-management capacity of COPD. 3. Increased self-efficacy in terms of their overall health behaviours. METHODS This pilot study is funded by GlaxoSmithKline Australia and recognised by the National Health and Medical Research Council through a scholarship to S.A. The study has approval from the Human Research Ethics Committee of UNSW Australia (HREC14139).",
author = "Sameera Ansari and Hassan Hosseinzadeh and Sarah Dennis and Nicholas Zwar",
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doi = "10.1038/s41533-016-0003-9",
language = "English",
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Activating primary care COPD patients with multi-morbidity (APCOM) pilot project : Study protocol. / Ansari, Sameera; Hosseinzadeh, Hassan; Dennis, Sarah; Zwar, Nicholas.

In: npj Primary Care Respiratory Medicine, Vol. 27, No. 1, 41533, 16.02.2017.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - Chronic obstructive pulmonary disease (COPD), third leading cause of mortality worldwide,1 is primarily caused by cigarette smoking in Australia.2 COPD often occurs in the presence of multi-morbidity, which is the simultaneous occurrence of two or more chronic conditions; this is a growing concern in a health system focused on single-disease management.3 Around 80% of older Australians have multi-morbidity, average prevalence of chronic respiratory disease being 9.5%.4 A systematic review of COPD education programs suggests that equipping patients with self-management skills is as important as disease knowledge.5 Studies exploring positive effects of chronic disease-management interventions6 also underline the lack of studies aimed at empowering patients. Although a recent Cochrane Review7 of COPD self-management interventions shows increased health-related quality of life and decreased probability of respiratory-related hospitalisation, similar interventions have not been consistently effective when applied in recent trials.8-10 Though interventions aimed at modifying COPD-related health behaviour have great potential, extant literature points to need for self-management programs in primary care. There is a dearth of interventions involving patients with multimorbidity, clinicians and other stakeholders, that can be generalisable to other populations.11 Patients with multimorbidity are often excluded from chronic disease-management trials; a Cochrane review12 of multi-morbidity interventions found only ten such studies. Our recent qualitative study,13 which explored the impact of COPD diagnosis in primary care patients with co-morbidities (co-existing chronic conditions), found suboptimal disease understanding and health-care utilisation. The above evidence demonstrates a need for development and testing interventions to increase self-management capacity in COPD patients with co-morbidities. Even a brief education session is effective in improving disease knowledge and response to symptoms;14 as demonstrated by selfmanagement interventions10, 15 on COPD which increased patient self-efficacy. Such programs do not only improve health status and prevent hospital remissions,16 but also lead to better patientprovider relationships, self-efficacy and sense of identity.17 With no prior study having seemed to focus on improving self-efficacy of COPD patients with co-morbidities in primary care, our study aims to empower these patients by trialling a tailored, practice nurse -delivered self-management program. AIMS This pre and post-test pilot study aims to trial the impact and feasibility of a tailored self-management program for primary care COPD patients with multi-morbidity. Our hypothesis is that at six months' follow-up, participants would have: 1. Better activation in terms of their COPD-related health behaviour. 2. Improved knowledge and self-management capacity of COPD. 3. Increased self-efficacy in terms of their overall health behaviours. METHODS This pilot study is funded by GlaxoSmithKline Australia and recognised by the National Health and Medical Research Council through a scholarship to S.A. The study has approval from the Human Research Ethics Committee of UNSW Australia (HREC14139).

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