Predictors of patient adherence to COPD self-management exacerbation action plans.

Autor: Schrijver J; Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. Electronic address: J.Schrijver@mst.nl., Effing TW; College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia., Brusse-Keizer M; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands., van der Palen J; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Research Methodology, Measurement, and Data-Analysis, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands., van der Valk P; Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands., Lenferink A; Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
Jazyk: angličtina
Zdroj: Patient education and counseling [Patient Educ Couns] 2021 Jan; Vol. 104 (1), pp. 163-170. Date of Electronic Publication: 2020 Jun 18.
DOI: 10.1016/j.pec.2020.06.015
Abstrakt: Objective: Identifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans.
Methods: Data were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with ≥1 exacerbation and/or ≥1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as 'self-initiating prednisolone treatment ≤2 days from the onset of a COPD exacerbation'. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics.
Results: 145 COPD patients were included and allocated to four adherence categories: 'optimal treatment' (26.2 %), 'sub optimal treatment' (11.7 %), 'significant delay or no treatment' (31.7 %), or 'treatment outside the actual exacerbation period' (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0-4) increased the risk of 'significant delay or no treatment' (OR 1.64 (95 % CI 1.07-2.50)). Cardiac comorbidity showed a borderline significant increased risk of 'treatment outside the actual exacerbation period' (OR 2.40 (95 % CI 0.98-5.85)).
Conclusion: More severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans.
Practice Implications: Tailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans.
Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: