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

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
• pulmonary rehabilitation
• exercise
• emphysema
• self-management

Acknowledgments

The authors thank the British Lung Foundation for funding, Dr Matthew Richardson for statistical advice, and Leicestershire, Northamptonshire, and Rutland and West Midlands (South) Comprehensive Local Research Networks for screening.

Presented as an oral presentation in mini symposium B16 at the American Thoracic Society 18th May 2015 – A Supported Self-Management Programme for Chronic Obstructive Pulmonary Disease (COPD) Upon Hospital Discharge: A Randomized Controlled Trial.

British Lung Foundation grant RB11-2.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work. SJS and KR were supported by the Collaboration for Leadership in Applied Health Research and Care, East and West Midlands, respectively and the NIHR Leicester Respiratory Biomedical Research Unit (BRU). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Disclosure

The authors report no conflicts of interest in this work.