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Randomized Controlled Trial
. 2016 Jun 2:11:1161-9.
doi: 10.2147/COPD.S91253. eCollection 2016.

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Vicki Johnson-Warrington  1 , Karen Rees  2 , Colin Gelder  3 , Mike D Morgan  4 , Sally J Singh  5
Affiliations
Randomized Controlled Trial

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Vicki Johnson-Warrington et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Introduction: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.

Objective: To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care.

Methods: This is a prospective, single-blinded, two-center trial (ISRCTN84599369) with participants admitted for an exacerbation, randomized to usual care or SPACE for COPD. Measures, including health-related quality of life and exercise capacity, were taken at baseline (hospital discharge) and at 3 months. The primary outcome measure was respiratory readmission at 3 months.

Results: Seventy-eight patients were recruited (n=39 to both groups). No differences were found in readmission rates or mortality at 3 months between the groups. Ten control patients were readmitted within 30 days compared to five patients in the intervention group (P>0.05). Both groups significantly improved their exercise tolerance and Chronic Respiratory Questionnaire (CRQ-SR) results, with between-group differences approaching statistical significance for CRQ-dyspnea and CRQ-emotion, in favor of the intervention. The "Ready for Home" survey revealed that patients receiving the intervention reported feeling better able to arrange their life to cope with COPD, knew when to seek help about feeling unwell, and more often took their medications as prescribed, compared to usual care (P<0.05).

Conclusion: SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.

Keywords: COPD exacerbations; emphysema; exercise; pulmonary rehabilitation; self-management.

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Figures

Figure 1
Figure 1
CONSORT diagram. Abbreviations: SPACE, Self-management Program of Activity, Coping, and Education; PR, pulmonary rehabilitation; MRC, Medical Research Council; UHCW, University Hospitals Coventry and Warwickshire NHS Trust; UHL, University Hospitals of Leicester NHS Trust.
Figure 2
Figure 2
Kaplan–Meier plots showing risk of respiratory readmission by randomization. Abbreviation: SPACE, Self-management Program of Activity, Coping, and Education.
Figure 3
Figure 3
Change in Chronic Respiratory Questionnaire – self reported data from baseline to 3 months. Note: *P<0.05, **P<0.01, within group difference. Abbreviations: NS, not significant; SPACE, Self management Programme of Activity Coping and Education; CRQ, Chronic Respiratory Questionnaire.
See this image and copyright information in PMC

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