Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: a randomized trial.
Autor: | Press VG; Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5000, W328, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu, Arora VM, Shah LM, Lewis SL, Charbeneau J, Naureckas ET, Krishnan JA |
---|---|
Jazyk: | angličtina |
Zdroj: | Journal of general internal medicine [J Gen Intern Med] 2012 Oct; Vol. 27 (10), pp. 1317-25. Date of Electronic Publication: 2012 May 17. |
DOI: | 10.1007/s11606-012-2090-9 |
Abstrakt: | Background: Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. Objective: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). Design: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. Participants: Hospitalized adults (age 18 years or older) with asthma or COPD. Interventions: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). Main Measures: The primary outcome was metered-dose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. Key Results: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p=0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02). Conclusions: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization health-related events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education. |
Databáze: | MEDLINE |
Externí odkaz: |