Authors (including presenting author) :
Ho CYC (1), Poon CL (2), Chan Yip WH (3)
Affiliation :
(1) School of Nursing, Union Hospital (2) Medical Department, United Christina Hospital (3) The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent chronic illness among older people in Hong Kong and worldwide . Acute exacerbations of COPD are common and it negatively affects the patient’s health status, morbidity, healthcare service utilization and disease progression . Formulating an action plan for COPD self- management is found effective for reducing COPD exacerbations and the related negative impacts thus COPD action plan is regarded as an important element in management of COPD . A COPD action plan focuses on when and how to perform some specific behaviors for dealing with acute exacerbations (Effing et al., 2016; Howcroft, Walters, Wood-Baker, & Walters, 2016), and the COPD patients should be trained to master these behaviors for dealing with sudden deterioration of respiratory symptoms (Howcroft et al., 2016).
Two Cochrane reviews supported that COPD action plans could be beneficial for COPD patients. A review concluded that the use of COPD exacerbation action plans with a single short educational component along with ongoing support reduces in- hospital healthcare service utilization (Howcroft et al., 2016). Another review also concluded that COPD exacerbation action plan are associated with improvement in health-related quality of life and reduce the chance of respiratory-related admissions.
However, the elderly COPD patients with low educational level demonstrate difficulties in accessing and understanding health-related information in clinical setting. They also find problematic in reading and understanding information on medicine packages or action plans, thus hindering their disease management. Several studies also revealed that people with low educational level are associated with lower health literacy and poorer health outcomes (Geboers, de Winter, Spoorenberg, Wynia, & Reijneveld,
2016; Roberts & Partridge, 2011). Among all the responders who are over 65 years old, 23.2% of them have not received any form of schooling whilst 60.4% has only attained primary education level or below (Census and Statistics Department, 2017). Given the fact that the prevalence of COPD will be increased from 0.04 million in 2010 to 0.12 million in 2036 (Chau et al., 2011) in the elderly population, the low education level among this group might have created a profound barrier in mastering the necessary knowledge and skills for management of their disease (Roberts & Partridge,2011; Wood-Baker, McGlone, Venn, & Walters, 2006). To alleviate issues related to low health literacy, visual aids such as pictograms could facilitate the delivery of medical information to people with limited literacy.
Objectives :
This study aims to evaluate the effectiveness of pictorial COPD action plan on reducing hospital readmissions in elderly patients with COPD in Hong Kong.
The objectives of this study are
i. To improve the patient’s recall of treatment regime
ii. To improve the patient’s comprehension of treatment regime
iii. To improve the patient’s health-related quality of life
iv. To improve the patient’s adherence to action plan
v. To improve the patient’s symptom control
vi. To reduce the patient’s unplanned emergency department visits
vii. To reduce the patient’s unplanned hospital readmissions
viii. To reduce the patient’s length of unplanned hospital stay
Methodology :
This study will adopt prospective, single-blind randomized controlled trial (RCT). Subjects will be randomly assigned to either the interventional group or the control group. Intervention group will receive pictorial COPD action plan and control group will receive written action plan.
Consecutive sampling will be adopted in this study. Every subject meeting inclusion criteria will be selected until required sample size is achieved. Consecutive sampling is better in controlling sampling bias.
Intention-to-treat analysis will also be adopted. Every subject who is randomized in this study would be included in the analysis. Non-compliance, protocol deviations, withdrawal or anything that happens after randomization will be ignored. The advantage of adopting intention-to-treat analysis is it could maintain prognostic balance generated from the original random treatment allocation and could also generate an unbiased estimation of treatment effect
