Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study

BACKGROUND: Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions.OBJECTIVE: To report the rationale for and methods of a study to develop evidence-informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD.METHODS: The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and/or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD.RESULTS: Clinical decision-making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework.CONCLUSION: The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an ‘activity as tolerated’ approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision-making tools for use by patients and their health care providers.

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Cigarette Smoking and Smoking Cessation among Persons with Chronic Obstructive Pulmonary Disease

American Journal of Health Promotion ◽

10.4278/0890-1171-20.5.319 ◽

2006 ◽

Vol 20 (5) ◽

pp. 319-323 ◽

Cited By ~ 19

Author(s):

Jeannine S. Schiller ◽

Hanyu Ni

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Smoking Cessation ◽

Pulmonary Disease ◽

Health Care Providers ◽

Activity Limitation ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

The Past

Purpose. To identify factors predictive of smoking cessation among adults with chronic obstructive pulmonary disease (COPD). Data from the 1997 to 2002 National Health Interview Surveys were analyzed for adults at least 25 years of age with COPD using logistic regression. Results. Of the adults with COPD, 36.2% were current smokers. Of the current smokers and former smokers who had quit smoking during the past year, 22.9% reported not receiving cessation advice from a health care professional during the past year. Although half of smokers with COPD had attempted to quit during the past year, only 14.6% were successful. Attempting to quit was negatively associated with heavy drinking but positively associated with being younger and having cardiovascular diseases, lung cancer, and activity limitation due to lung problems. Factors predictive of successful cessation included being at least 65 years old, not being poor, and activity limitation due to lung problems. Conclusion. This study underscores the importance of continuing to develop smoking cessation strategies for COPD patients and implementing clinical guidelines on smoking cessation among health care providers.

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The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

Medicina ◽

10.3390/medicina57070726 ◽

2021 ◽

Vol 57 (7) ◽

pp. 726

Author(s):

Claudio F. Donner ◽

Richard ZuWallack ◽

Linda Nici

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Disease Management ◽

Pulmonary Disease ◽

Health Care Providers ◽

Medical Management ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease

Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.

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Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

BMC Health Services Research ◽

10.1186/1472-6963-13-363 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Cecile MA Utens ◽

Lucas MA Goossens ◽

Onno CP van Schayck ◽

Maureen PHM Rutten-vanMölken ◽

Maria W Braken ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Pulmonary Disease ◽

Health Care Providers ◽

Survey Study ◽

Role Transition ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

Hospital At Home

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How integrated are services for patients with chronic obstructive pulmonary disease? Perceptions of patients and health care providers

Australian Journal of Primary Health ◽

10.1071/py12147 ◽

2014 ◽

Vol 20 (2) ◽

pp. 158 ◽

Cited By ~ 3

Author(s):

S. E. Kirby ◽

M. Mutimbe ◽

S. Vagholkar ◽

J. Bunker ◽

S. M. Dennis ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Pulmonary Disease ◽

Health Care Providers ◽

Community Services ◽

Chronic Obstructive ◽

Care Providers ◽

Integration Of Care ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Chronic obstructive pulmonary disease (COPD) is a common cause of hospital readmissions worldwide. Outcomes for COPD patients improve if care is more integrated. COPD patients and their health care providers at a district hospital and community health service were interviewed about their perceptions of integration of care. Patients were confused about provider roles, had little understanding of their disease, had difficulty accessing services and did not have COPD action plans. Health care providers espoused integration of COPD care. Care was reasonably well integrated in the hospital. Integration of care was compromised in the community because COPD patients went to the emergency department when symptoms became unmanageable, while only attending their GPs for routine booked appointments. Integration could be improved if health care providers spent more time with patients, promoting understanding of the disease, supporting self-management and liaising with other providers. Patients would benefit from an action plan and additional support. Potentially preventable COPD admissions will continue without action to improve integration of community services and patients’ understanding of their condition.

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Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective (Preprint)

10.2196/preprints.18148 ◽

2020 ◽

Cited By ~ 1

Author(s):

Florence van Lieshout ◽

Rebecca Yang ◽

Vess Stamenova ◽

Payal Agarwal ◽

Daniel Cornejo Palma ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Pulmonary Disease ◽

Health Care Providers ◽

Remote Monitoring ◽

Monitoring Program ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

Health Technologies

BACKGROUND Implementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected. OBJECTIVE The goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care. METHODS This study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework. RESULTS Findings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service. CONCLUSIONS Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep—an unanticipated expanding scope of work activities in relation to the function of the tool.

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Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective

Journal of Medical Internet Research ◽

10.2196/18148 ◽

2020 ◽

Vol 22 (10) ◽

pp. e18148

Author(s):

Florence van Lieshout ◽

Rebecca Yang ◽

Vess Stamenova ◽

Payal Agarwal ◽

Daniel Cornejo Palma ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Pulmonary Disease ◽

Health Care Providers ◽

Remote Monitoring ◽

Monitoring Program ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

Health Technologies

Background Implementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected. Objective The goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care. Methods This study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework. Results Findings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service. Conclusions Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep—an unanticipated expanding scope of work activities in relation to the function of the tool.

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Illness representations of chronic obstructive pulmonary disease (COPD) to inform health education strategies and research design—learning from rural Uganda

Health Education Research ◽

10.1093/her/cyaa016 ◽

2020 ◽

Vol 35 (4) ◽

pp. 258-269

Author(s):

Emily M Nagourney ◽

Nicole M Robertson ◽

Natalie Rykiel ◽

Trishul Siddharthan ◽

Patricia Alupo ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Health Care ◽

Pulmonary Disease ◽

Health Care Providers ◽

Illness Representations ◽

Chronic Obstructive ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

Village Health ◽

Village Health Teams

Abstract More than 90% of chronic obstructive pulmonary disease (COPD)-related deaths occur in low- and middle-income countries; however, few studies have examined the illness experiences of individuals living with and providing treatment for COPD in these settings. This study characterizes illness representations for COPD in Nakaseke, Uganda from the perspectives of health care providers, village health teams and community members (CMs) with COPD. We conducted 40 in-depth, semi-structured interviews (16 health care providers, 12 village health teams and 12 CMs, aged 25–80 years). Interviews were analyzed using inductive coding, and the Illness Representations Model guided our analysis. Stakeholder groups showed concordance in identifying causal mechanisms of COPD, but showed disagreement in reasons for care seeking behaviors and treatment preferences. CMs did not use a distinct label to differentiate COPD from other respiratory illnesses, and described both the physical and social consequences of COPD. Local representations can inform development of adapted educational and self-management tools for COPD.

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