A Novel Approach to Reducing COPD Readmissions
Motivational interviewing is a health coaching, goal-oriented, client-centered counseling style for eliciting behavior changes. In order to determine if this intervention may reduce short-term COPD readmissions, researchers randomized hospitalized patients with COPD to standard care or health coaching and followed them for 1 year. Health coaching included at least one session in the hospital and one session after patients were discharged. The intervention group also received weekly phone-based sessions for 3 months and then monthly thereafter. Among patients who received the health coaching intervention, COPD-related readmissions were cut by 7.5% in the first month and 11.0% at 3 and 6 months, when compared with the standard care group.
Home- Vs Hospital-Based Pulmonary Rehab
Studies have shown that pulmonary rehabilitation improves exercise capacity and symptoms and helps reduce readmission rates in patients with COPD. However, data indicate that less than 10% of COPD patients enter a pulmonary rehab program. Home-based pulmonary rehab may improve participation by avoiding the need for patients who are short of breath to travel to a hospital or other facility. For a study, investigators compared an 8-week, at-home pulmonary rehab program with their hospital’s standard program. Costs were similar for both programs. Immediately following the 8 weeks, results on all measures were comparable between the two groups. However, neither group retained primary or secondary gains at 12 months.
Cardiopulmonary Fitness & Lung Health
Research on factors associated with lung health and age has focused mostly on smoking. Whether cardiopulmonary fitness among young adults is associated with the preservation of lung health over time has yet to be determined. For a study, healthy Caucasian and African-American patients aged 18 to 30 underwent measurements of their cardiopulmonary fitness at baseline and 20 years. Patients with the highest levels of baseline fitness had significantly less decline in forced vital capacity when compared with others. Those who sustained higher fitness levels had significantly less decline in lung function than those sustaining lower fitness levels or who had relative decreases in fitness.
Poor Sleep Quality Increases COPD Exacerbation Risk
Prior studies have shown that sleep disorders and COPD are both common and often comorbid conditions among older adults. However, few studies have assessed how sleep disorders affect COPD-related outcomes. Canadian researchers measured sleep quality at baseline among more than 1,500 COPD patients using the Pittsburgh Sleep Quality Index (PSQI). Patients self-reported exacerbations of their disease, which were confirmed by a study coordinator every 3 months and classified by severity. Every 2-point increase in baseline PSQI score was associated with a 10% increase in risk of symptom-based COPD exacerbations over 18 months. Every 1-point increase in baseline daily sleep disturbance score was associated with a 50% increase in risk of both symptom- and event-based exacerbations over the study period.
Assessing COPD Treatment Access
To better understand barriers to COPD care in the United States and propose potential solutions, a committee of experts in respiratory medicine shared and then summarized their opinions based on recent data. The general consensus was that many patients with COPD lack access to basic therapies and care, primarily due to financial constraints. Access was dependent on a patient’s insurance status, geographic location, and socioeconomic status. COPD-related guidelines were also found to be poorly implemented. Despite growing attention on reducing COPD-related hospital readmissions, many healthcare systems struggle to meet goals and frequently use unproven methods when managing patients. The committee recommended engaging patients and innovative thinkers in the development of solutions. They also suggested financial incentives to raise provider and healthcare system engagement. Lowering co-pays for maintenance drugs may improve medication adherence and ultimately decrease overall healthcare spending.
NEWS FROM ATS 2016
MORE FROM ATS 2016