Background and Aims: COPD often occurs in the presence of co-morbidities which impact presentatio... more Background and Aims: COPD often occurs in the presence of co-morbidities which impact presentation of symptoms, disease progression and resulting mortality. Patients with COPD usually have little understanding about implications of the condition and its management, especially in primary care. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study, conducted in Sydney general practice, aimed to empower patients in terms of their COPD self-efficacy in the face of their existing co-morbidities.
Methods: The study included patients aged between 40 and 84 years with a recorded spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program for COPD in the context of multi-morbidity, developed by the researchers based on the Health Belief Model, was tailored and delivered to the patients by trained practice nurses in three one-to-one sessions. Impact of the program was assessed by the Patient Activation Measure (PAM 13), COPD Knowledge Questionnaire (COPD-Q), COPD Assessment Test (CAT), Multimorbidity Illness Perceptions Scale (MULTIPleS), Morisky Medication Adherence Scale (MMAS-8) and accuracy of inhaler technique.
Results: Among 50 patients at baseline (25 males and 25 females, mean age: 69.22), 44 completed six months’ follow-up. Pre and post-test comparison of their data showed significant improvement in patient activation from 57.69 to 64.85 (p<0.001), COPD knowledge from 7.27 to 9.02 (p<0.001) and clinical impact of COPD from 20 to 17.55 (p=0.012). Perception of their multi-morbidity and medication adherence were slightly enhanced from 25.58 to 26.02 (p=0.822) and 1.88 to 1.5 (p=0.139) respectively. Number of patients who performed their inhaler technique accurately increased from 5 at baseline to 20 at post-test (p=0.001).
Conclusions: The study was successful in improving the patient’s COPD self-efficacy. The findings form an evidence base for upscaling the program to be tested in a larger trial to further assess its impact in day-to-day general practice.
Background: COPD often occurs in the presence of co-morbidities which impact its presentation and... more Background: COPD often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD.
Aims: The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients with their COPD self-efficacy and overall health behaviour in general practices in Sydney, Australia.
Methods: This interventional study included patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses (PNs). Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique. Qualitative evaluation of the SMEP was done by interviewing PNs, general physicians (GPs) and patients.
Results: Pre and post-test comparison of data from 44 patients who completed 6 months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), impact of COPD (p=0.012) and accuracy of inhaler technique (p=0.001). The qualitative interviews, currently being analysed, have yielded mostly positive feedback.
Conclusions: The study successfully increased self-efficacy of COPD patients and their overall health behaviour, forming an evidence base to test the SMEP in a future randomised controlled trial.
Context and aims: Chronic obstructive pulmonary disease (COPD) often occurs in the presence of co... more Context and aims: Chronic obstructive pulmonary disease (COPD) often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients in terms of their COPD self-efficacy and overall health behaviour in general practices in Sydney, New South Wales, Australia.
Methods: This interventional study included 50 patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses in a series of one-to-one sessions. Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: Pre and post-test comparison of data from 44 patients who completed six months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), reduced impact of COPD (p=0.012) and better accuracy of inhaler technique (p=0.001).
Innovative contribution to practice and research: The study successfully increased self-efficacy of COPD patients and their overall health behaviour through its innovative SMEP. The findings form a strong evidence base to further test the SMEP in a future randomised controlled trial. This capacity-building initiative also promoted collaboration and knowledge translation between the participating stakeholders.
Background: Understanding of COPD and uptake of evidence-based healthcare by patients is suboptim... more Background: Understanding of COPD and uptake of evidence-based healthcare by patients is suboptimal in primary care, particularly in the context of multi-morbidity. This innovative study aims to empower primary care COPD patients with co-morbidities by improving their disease knowledge and self-efficacy by piloting a practice nurse-delivered, tailored self-management programme in Sydney, Australia.
Methods: Potential COPD patients with co-morbidities were recruited from participating general practices. Following an initial needs assessment, the self-management programme is being tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The programme, based on constructs from the Health Belief Model, involves active engagement of patients with strategies aimed at enhancing their COPD knowledge, self-management capacity and skills in prioritisating multiple chronic conditions. Primary outcome of the study is assessment of patient knowledge, skills and self-management capacity of multiple chronic conditions using the Patient Activation Measure (PAM). Secondary outcome measures include COPD Knowledge Questionnaire, COPD Assessment Test, Multi-morbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: The study is currently in the phase of intervention delivery and follow-up. The average PAM score from baseline data of 49 participants (24 male and 25 female, mean age: 69.2) was 57.67, indicating lack of confidence and skill to modify health behaviour. Impact of the programme will be tested by comparing pre and post-test outcome measures after six months’ follow-up. Feasibility and sustainability will be evaluated by qualitative feedback from participating clinicians.
Implications: There has been good uptake of the programme by participating nurses following training workshops conducted by the researchers. We have faced challenges in practice recruitment and patient retention, mainly due to their co-morbidities. A first of its kind, our study could lead to improved long-term health outcomes, healthcare utilisation and patient-provider relationships. The study also broadens the practice nurse’s role in patient empowerment, which is vital given the surge in multi-morbidity worldwide.
Aims & rationale: Understanding of chronic obstructive pulmonary disease (COPD) and uptake of rel... more Aims & rationale: Understanding of chronic obstructive pulmonary disease (COPD) and uptake of relevant healthcare by patients is suboptimal, especially in primary care, further complicated by the presence of co-morbidities. This innovative pilot project aims to empower primary care COPD patients with multi-morbidity by improving their disease knowledge and self-efficacy through a practice nurse-delivered, tailored self-management intervention.
Methods: Potential participants (N=40) will be identified from Sydney general practices based on: i) age between 40 - 84 years, ii) COPD diagnosis ≤ 24 months, iii) presence of one or more co-morbidity and iv) history of smoking. Following an initial needs assessment, the self-management intervention based on Health Belief Model will be tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The intervention framework, which includes constructs from renowned self-care models, will involve active engagement of patients with strategies towards enhancing their COPD knowledge, self-management capacity and prioritisation of multiple chronic conditions. Impact of the intervention will be measured by pre and post-test outcome measures covering activation, knowledge, beliefs and self-efficacy regarding COPD and multi-morbidity. After a 6-month follow-up period, feasibility and sustainability of the intervention will be evaluated by qualitative feedback from participating healthcare providers.
Relevance to policy, research and/or practice needs: No prior study has focused on improving self-efficacy of recently-diagnosed COPD patients with multi-morbidity. The project seeks to motivate these patients to actively manage their COPD while effectively balancing other chronic conditions, which will lead to improved long-term health outcomes, better healthcare utilisation and enhanced patient-provider relationships.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortal... more Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and often co-exists with other chronic conditions which may influence the disease. This qualitative study aimed to explore the biopsychosocial impact of a new diagnosis of COPD in the context of multi-morbidity.
Methods: Participants were from a cohort of recently-diagnosed COPD patients in primary care with multi-morbidity. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis and a constructivist approach were used to interpret the data.
Results: Five core themes were induced regarding participants’ perspectives of COPD diagnosis. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Conclusion: This study is believed to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients’ perspectives in primary care.
Aims & rationale: COPD, a major cause of morbidity and mortality worldwide, often occurs in the p... more Aims & rationale: COPD, a major cause of morbidity and mortality worldwide, often occurs in the presence of co-morbidities which may influence experience and management of the disease. No prior study seemed to have gained perspectives of newly-diagnosed primary care COPD patients, particularly in relation to their co-morbidities. This qualitative study aimed to explore the biopsychosocial impact of a new diagnosis of COPD in the context of multi-morbidity and to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multi-morbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis was performed and a constructivist approach used to interpret the data.
Principal findings: Five core themes were induced regarding participants' perspectives of COPD diagnosis and their co-morbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Implications: This study is thought to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients' perspectives in primary care.
Background: A major cause of morbidity and mortality worldwide, COPD often occurs in the presence... more Background: A major cause of morbidity and mortality worldwide, COPD often occurs in the presence of multiple other related or unrelated health conditions, which may have implications for experience and management of the disease; a phenomenon known as multimorbidity. Little research has been done exploring patients' perspectives of COPD and even less is known about impact of comorbidities on the disease.
Aim of Study: This qualitative study was conducted to understand the physical, psychological and social impact of a new diagnosis of COPD in the context of multimorbidity.
Methods: Participants were diagnosed with COPD during a Sydney-based randomised control trial of case finding and early intervention in COPD. From 254 participants in the trial, 20 participants were identified for the qualitative study using maximum variation sampling based on age, gender, socio-economic status, geographic location and severity of COPD. Data was collected via semi-structured interviews and recorded for transcription purposes.
Results: In spite of accepting the diagnosis, most participants had difficulty recognising the significance and incorporating COPD into their lives. Self-management capacity and ability to use healthcare services were challenged by limited understanding of COPD and its implications, complications presented by comorbidities and financial barriers (eg. cost of consulting a specialist). In many cases, the salience of another chronic condition (eg. diabetes) outweighed that of COPD.
Conclusion: The findings provide an insight into how patients prioritise health conditions, highlighting the importance of understanding and incorporating their perspectives through patient-centered practice, tailored education and development of personalised care plans for COPD patients with multimorbidity.
Background: Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortalit... more Background: Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortality worldwide, often occurs in the presence of comorbidities, which may influence experience and management of the disease. No prior research seems to have gained perspectives of newly diagnosed primary care COPD patients in the context of multimorbidity.
Aims: This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective.
Results: Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities.
Conclusions: This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.
Background and Aims: COPD often occurs in the presence of co-morbidities which impact presentatio... more Background and Aims: COPD often occurs in the presence of co-morbidities which impact presentation of symptoms, disease progression and resulting mortality. Patients with COPD usually have little understanding about implications of the condition and its management, especially in primary care. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study, conducted in Sydney general practice, aimed to empower patients in terms of their COPD self-efficacy in the face of their existing co-morbidities.
Methods: The study included patients aged between 40 and 84 years with a recorded spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program for COPD in the context of multi-morbidity, developed by the researchers based on the Health Belief Model, was tailored and delivered to the patients by trained practice nurses in three one-to-one sessions. Impact of the program was assessed by the Patient Activation Measure (PAM 13), COPD Knowledge Questionnaire (COPD-Q), COPD Assessment Test (CAT), Multimorbidity Illness Perceptions Scale (MULTIPleS), Morisky Medication Adherence Scale (MMAS-8) and accuracy of inhaler technique.
Results: Among 50 patients at baseline (25 males and 25 females, mean age: 69.22), 44 completed six months’ follow-up. Pre and post-test comparison of their data showed significant improvement in patient activation from 57.69 to 64.85 (p<0.001), COPD knowledge from 7.27 to 9.02 (p<0.001) and clinical impact of COPD from 20 to 17.55 (p=0.012). Perception of their multi-morbidity and medication adherence were slightly enhanced from 25.58 to 26.02 (p=0.822) and 1.88 to 1.5 (p=0.139) respectively. Number of patients who performed their inhaler technique accurately increased from 5 at baseline to 20 at post-test (p=0.001).
Conclusions: The study was successful in improving the patient’s COPD self-efficacy. The findings form an evidence base for upscaling the program to be tested in a larger trial to further assess its impact in day-to-day general practice.
Background: COPD often occurs in the presence of co-morbidities which impact its presentation and... more Background: COPD often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD.
Aims: The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients with their COPD self-efficacy and overall health behaviour in general practices in Sydney, Australia.
Methods: This interventional study included patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses (PNs). Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique. Qualitative evaluation of the SMEP was done by interviewing PNs, general physicians (GPs) and patients.
Results: Pre and post-test comparison of data from 44 patients who completed 6 months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), impact of COPD (p=0.012) and accuracy of inhaler technique (p=0.001). The qualitative interviews, currently being analysed, have yielded mostly positive feedback.
Conclusions: The study successfully increased self-efficacy of COPD patients and their overall health behaviour, forming an evidence base to test the SMEP in a future randomised controlled trial.
Context and aims: Chronic obstructive pulmonary disease (COPD) often occurs in the presence of co... more Context and aims: Chronic obstructive pulmonary disease (COPD) often occurs in the presence of co-morbidities which impact its presentation and management. Primary care patients usually have low self-efficacy in terms of disease knowledge and healthcare utilisation for their COPD. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients in terms of their COPD self-efficacy and overall health behaviour in general practices in Sydney, New South Wales, Australia.
Methods: This interventional study included 50 patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses in a series of one-to-one sessions. Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: Pre and post-test comparison of data from 44 patients who completed six months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), reduced impact of COPD (p=0.012) and better accuracy of inhaler technique (p=0.001).
Innovative contribution to practice and research: The study successfully increased self-efficacy of COPD patients and their overall health behaviour through its innovative SMEP. The findings form a strong evidence base to further test the SMEP in a future randomised controlled trial. This capacity-building initiative also promoted collaboration and knowledge translation between the participating stakeholders.
Background: Understanding of COPD and uptake of evidence-based healthcare by patients is suboptim... more Background: Understanding of COPD and uptake of evidence-based healthcare by patients is suboptimal in primary care, particularly in the context of multi-morbidity. This innovative study aims to empower primary care COPD patients with co-morbidities by improving their disease knowledge and self-efficacy by piloting a practice nurse-delivered, tailored self-management programme in Sydney, Australia.
Methods: Potential COPD patients with co-morbidities were recruited from participating general practices. Following an initial needs assessment, the self-management programme is being tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The programme, based on constructs from the Health Belief Model, involves active engagement of patients with strategies aimed at enhancing their COPD knowledge, self-management capacity and skills in prioritisating multiple chronic conditions. Primary outcome of the study is assessment of patient knowledge, skills and self-management capacity of multiple chronic conditions using the Patient Activation Measure (PAM). Secondary outcome measures include COPD Knowledge Questionnaire, COPD Assessment Test, Multi-morbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: The study is currently in the phase of intervention delivery and follow-up. The average PAM score from baseline data of 49 participants (24 male and 25 female, mean age: 69.2) was 57.67, indicating lack of confidence and skill to modify health behaviour. Impact of the programme will be tested by comparing pre and post-test outcome measures after six months’ follow-up. Feasibility and sustainability will be evaluated by qualitative feedback from participating clinicians.
Implications: There has been good uptake of the programme by participating nurses following training workshops conducted by the researchers. We have faced challenges in practice recruitment and patient retention, mainly due to their co-morbidities. A first of its kind, our study could lead to improved long-term health outcomes, healthcare utilisation and patient-provider relationships. The study also broadens the practice nurse’s role in patient empowerment, which is vital given the surge in multi-morbidity worldwide.
Aims & rationale: Understanding of chronic obstructive pulmonary disease (COPD) and uptake of rel... more Aims & rationale: Understanding of chronic obstructive pulmonary disease (COPD) and uptake of relevant healthcare by patients is suboptimal, especially in primary care, further complicated by the presence of co-morbidities. This innovative pilot project aims to empower primary care COPD patients with multi-morbidity by improving their disease knowledge and self-efficacy through a practice nurse-delivered, tailored self-management intervention.
Methods: Potential participants (N=40) will be identified from Sydney general practices based on: i) age between 40 - 84 years, ii) COPD diagnosis ≤ 24 months, iii) presence of one or more co-morbidity and iv) history of smoking. Following an initial needs assessment, the self-management intervention based on Health Belief Model will be tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The intervention framework, which includes constructs from renowned self-care models, will involve active engagement of patients with strategies towards enhancing their COPD knowledge, self-management capacity and prioritisation of multiple chronic conditions. Impact of the intervention will be measured by pre and post-test outcome measures covering activation, knowledge, beliefs and self-efficacy regarding COPD and multi-morbidity. After a 6-month follow-up period, feasibility and sustainability of the intervention will be evaluated by qualitative feedback from participating healthcare providers.
Relevance to policy, research and/or practice needs: No prior study has focused on improving self-efficacy of recently-diagnosed COPD patients with multi-morbidity. The project seeks to motivate these patients to actively manage their COPD while effectively balancing other chronic conditions, which will lead to improved long-term health outcomes, better healthcare utilisation and enhanced patient-provider relationships.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortal... more Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and often co-exists with other chronic conditions which may influence the disease. This qualitative study aimed to explore the biopsychosocial impact of a new diagnosis of COPD in the context of multi-morbidity.
Methods: Participants were from a cohort of recently-diagnosed COPD patients in primary care with multi-morbidity. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis and a constructivist approach were used to interpret the data.
Results: Five core themes were induced regarding participants’ perspectives of COPD diagnosis. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Conclusion: This study is believed to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients’ perspectives in primary care.
Aims & rationale: COPD, a major cause of morbidity and mortality worldwide, often occurs in the p... more Aims & rationale: COPD, a major cause of morbidity and mortality worldwide, often occurs in the presence of co-morbidities which may influence experience and management of the disease. No prior study seemed to have gained perspectives of newly-diagnosed primary care COPD patients, particularly in relation to their co-morbidities. This qualitative study aimed to explore the biopsychosocial impact of a new diagnosis of COPD in the context of multi-morbidity and to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multi-morbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis was performed and a constructivist approach used to interpret the data.
Principal findings: Five core themes were induced regarding participants' perspectives of COPD diagnosis and their co-morbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Implications: This study is thought to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients' perspectives in primary care.
Background: A major cause of morbidity and mortality worldwide, COPD often occurs in the presence... more Background: A major cause of morbidity and mortality worldwide, COPD often occurs in the presence of multiple other related or unrelated health conditions, which may have implications for experience and management of the disease; a phenomenon known as multimorbidity. Little research has been done exploring patients' perspectives of COPD and even less is known about impact of comorbidities on the disease.
Aim of Study: This qualitative study was conducted to understand the physical, psychological and social impact of a new diagnosis of COPD in the context of multimorbidity.
Methods: Participants were diagnosed with COPD during a Sydney-based randomised control trial of case finding and early intervention in COPD. From 254 participants in the trial, 20 participants were identified for the qualitative study using maximum variation sampling based on age, gender, socio-economic status, geographic location and severity of COPD. Data was collected via semi-structured interviews and recorded for transcription purposes.
Results: In spite of accepting the diagnosis, most participants had difficulty recognising the significance and incorporating COPD into their lives. Self-management capacity and ability to use healthcare services were challenged by limited understanding of COPD and its implications, complications presented by comorbidities and financial barriers (eg. cost of consulting a specialist). In many cases, the salience of another chronic condition (eg. diabetes) outweighed that of COPD.
Conclusion: The findings provide an insight into how patients prioritise health conditions, highlighting the importance of understanding and incorporating their perspectives through patient-centered practice, tailored education and development of personalised care plans for COPD patients with multimorbidity.
Background: Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortalit... more Background: Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortality worldwide, often occurs in the presence of comorbidities, which may influence experience and management of the disease. No prior research seems to have gained perspectives of newly diagnosed primary care COPD patients in the context of multimorbidity.
Aims: This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective.
Results: Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities.
Conclusions: This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.
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Conference Presentations by Sameera Ansari
Methods: The study included patients aged between 40 and 84 years with a recorded spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program for COPD in the context of multi-morbidity, developed by the researchers based on the Health Belief Model, was tailored and delivered to the patients by trained practice nurses in three one-to-one sessions. Impact of the program was assessed by the Patient Activation Measure (PAM 13), COPD Knowledge Questionnaire (COPD-Q), COPD Assessment Test (CAT), Multimorbidity Illness Perceptions Scale (MULTIPleS), Morisky Medication Adherence Scale (MMAS-8) and accuracy of inhaler technique.
Results: Among 50 patients at baseline (25 males and 25 females, mean age: 69.22), 44 completed six months’ follow-up. Pre and post-test comparison of their data showed significant improvement in patient activation from 57.69 to 64.85 (p<0.001), COPD knowledge from 7.27 to 9.02 (p<0.001) and clinical impact of COPD from 20 to 17.55 (p=0.012). Perception of their multi-morbidity and medication adherence were slightly enhanced from 25.58 to 26.02 (p=0.822) and 1.88 to 1.5 (p=0.139) respectively. Number of patients who performed their inhaler technique accurately increased from 5 at baseline to 20 at post-test (p=0.001).
Conclusions: The study was successful in improving the patient’s COPD self-efficacy. The findings form an evidence base for upscaling the program to be tested in a larger trial to further assess its impact in day-to-day general practice.
Aims: The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients with their COPD self-efficacy and overall health behaviour in general practices in Sydney, Australia.
Methods: This interventional study included patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses (PNs). Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique. Qualitative evaluation of the SMEP was done by interviewing PNs, general physicians (GPs) and patients.
Results: Pre and post-test comparison of data from 44 patients who completed 6 months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), impact of COPD (p=0.012) and accuracy of inhaler technique (p=0.001). The qualitative interviews, currently being analysed, have yielded mostly positive feedback.
Conclusions: The study successfully increased self-efficacy of COPD patients and their overall health behaviour, forming an evidence base to test the SMEP in a future randomised controlled trial.
Methods: This interventional study included 50 patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses in a series of one-to-one sessions. Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: Pre and post-test comparison of data from 44 patients who completed six months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), reduced impact of COPD (p=0.012) and better accuracy of inhaler technique (p=0.001).
Innovative contribution to practice and research: The study successfully increased self-efficacy of COPD patients and their overall health behaviour through its innovative SMEP. The findings form a strong evidence base to further test the SMEP in a future randomised controlled trial. This capacity-building initiative also promoted collaboration and knowledge translation between the participating stakeholders.
Methods: Potential COPD patients with co-morbidities were recruited from participating general practices. Following an initial needs assessment, the self-management programme is being tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The programme, based on constructs from the Health Belief Model, involves active engagement of patients with strategies aimed at enhancing their COPD knowledge, self-management capacity and skills in prioritisating multiple chronic conditions. Primary outcome of the study is assessment of patient knowledge, skills and self-management capacity of multiple chronic conditions using the Patient Activation Measure (PAM). Secondary outcome measures include COPD Knowledge Questionnaire, COPD Assessment Test, Multi-morbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: The study is currently in the phase of intervention delivery and follow-up. The average PAM score from baseline data of 49 participants (24 male and 25 female, mean age: 69.2) was 57.67, indicating lack of confidence and skill to modify health behaviour. Impact of the programme will be tested by comparing pre and post-test outcome measures after six months’ follow-up. Feasibility and sustainability will be evaluated by qualitative feedback from participating clinicians.
Implications: There has been good uptake of the programme by participating nurses following training workshops conducted by the researchers. We have faced challenges in practice recruitment and patient retention, mainly due to their co-morbidities. A first of its kind, our study could lead to improved long-term health outcomes, healthcare utilisation and patient-provider relationships. The study also broadens the practice nurse’s role in patient empowerment, which is vital given the surge in multi-morbidity worldwide.
Methods: Potential participants (N=40) will be identified from Sydney general practices based on: i) age between 40 - 84 years, ii) COPD diagnosis ≤ 24 months, iii) presence of one or more co-morbidity and iv) history of smoking. Following an initial needs assessment, the self-management intervention based on Health Belief Model will be tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The intervention framework, which includes constructs from renowned self-care models, will involve active engagement of patients with strategies towards enhancing their COPD knowledge, self-management capacity and prioritisation of multiple chronic conditions. Impact of the intervention will be measured by pre and post-test outcome measures covering activation, knowledge, beliefs and self-efficacy regarding COPD and multi-morbidity. After a 6-month follow-up period, feasibility and sustainability of the intervention will be evaluated by qualitative feedback from participating healthcare providers.
Relevance to policy, research and/or practice needs: No prior study has focused on improving self-efficacy of recently-diagnosed COPD patients with multi-morbidity. The project seeks to motivate these patients to actively manage their COPD while effectively balancing other chronic conditions, which will lead to improved long-term health outcomes, better healthcare utilisation and enhanced patient-provider relationships.
Methods: Participants were from a cohort of recently-diagnosed COPD patients in primary care with multi-morbidity. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis and a constructivist approach were used to interpret the data.
Results: Five core themes were induced regarding participants’ perspectives of COPD diagnosis. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Conclusion: This study is believed to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients’ perspectives in primary care.
Methods: Participants were identified from a cohort of primary care patients with multi-morbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis was performed and a constructivist approach used to interpret the data.
Principal findings: Five core themes were induced regarding participants' perspectives of COPD diagnosis and their co-morbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Implications: This study is thought to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients' perspectives in primary care.
Aim of Study: This qualitative study was conducted to understand the physical, psychological and social impact of a new diagnosis of COPD in the context of multimorbidity.
Methods: Participants were diagnosed with COPD during a Sydney-based randomised control trial of case finding and early intervention in COPD. From 254 participants in the trial, 20 participants were identified for the qualitative study using maximum variation sampling based on age, gender, socio-economic status, geographic location and severity of COPD. Data was collected via semi-structured interviews and recorded for transcription purposes.
Results: In spite of accepting the diagnosis, most participants had difficulty recognising the significance and incorporating COPD into their lives. Self-management capacity and ability to use healthcare services were challenged by limited understanding of COPD and its implications, complications presented by comorbidities and financial barriers (eg. cost of consulting a specialist). In many cases, the salience of another chronic condition (eg. diabetes) outweighed that of COPD.
Conclusion: The findings provide an insight into how patients prioritise health conditions, highlighting the importance of understanding and incorporating their perspectives through patient-centered practice, tailored education and development of personalised care plans for COPD patients with multimorbidity.
Papers by Sameera Ansari
Aims: This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective.
Results: Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities.
Conclusions: This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.
Methods: The study included patients aged between 40 and 84 years with a recorded spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program for COPD in the context of multi-morbidity, developed by the researchers based on the Health Belief Model, was tailored and delivered to the patients by trained practice nurses in three one-to-one sessions. Impact of the program was assessed by the Patient Activation Measure (PAM 13), COPD Knowledge Questionnaire (COPD-Q), COPD Assessment Test (CAT), Multimorbidity Illness Perceptions Scale (MULTIPleS), Morisky Medication Adherence Scale (MMAS-8) and accuracy of inhaler technique.
Results: Among 50 patients at baseline (25 males and 25 females, mean age: 69.22), 44 completed six months’ follow-up. Pre and post-test comparison of their data showed significant improvement in patient activation from 57.69 to 64.85 (p<0.001), COPD knowledge from 7.27 to 9.02 (p<0.001) and clinical impact of COPD from 20 to 17.55 (p=0.012). Perception of their multi-morbidity and medication adherence were slightly enhanced from 25.58 to 26.02 (p=0.822) and 1.88 to 1.5 (p=0.139) respectively. Number of patients who performed their inhaler technique accurately increased from 5 at baseline to 20 at post-test (p=0.001).
Conclusions: The study was successful in improving the patient’s COPD self-efficacy. The findings form an evidence base for upscaling the program to be tested in a larger trial to further assess its impact in day-to-day general practice.
Aims: The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) pilot study aimed to empower patients with their COPD self-efficacy and overall health behaviour in general practices in Sydney, Australia.
Methods: This interventional study included patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses (PNs). Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique. Qualitative evaluation of the SMEP was done by interviewing PNs, general physicians (GPs) and patients.
Results: Pre and post-test comparison of data from 44 patients who completed 6 months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), impact of COPD (p=0.012) and accuracy of inhaler technique (p=0.001). The qualitative interviews, currently being analysed, have yielded mostly positive feedback.
Conclusions: The study successfully increased self-efficacy of COPD patients and their overall health behaviour, forming an evidence base to test the SMEP in a future randomised controlled trial.
Methods: This interventional study included 50 patients aged 40 to 84 years with a spirometry diagnosis of COPD and at least one other co-morbidity. A self-management education program (SMEP) for COPD in the context of multi-morbidity, developed by the researchers, was tailored and delivered to the patients by trained practice nurses in a series of one-to-one sessions. Impact of the SMEP was assessed by Patient Activation Measure, COPD Knowledge Questionnaire, COPD Assessment Test, Multimorbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: Pre and post-test comparison of data from 44 patients who completed six months’ follow-up show significant improvement in patient activation (p<0.001), COPD knowledge (p<0.001), reduced impact of COPD (p=0.012) and better accuracy of inhaler technique (p=0.001).
Innovative contribution to practice and research: The study successfully increased self-efficacy of COPD patients and their overall health behaviour through its innovative SMEP. The findings form a strong evidence base to further test the SMEP in a future randomised controlled trial. This capacity-building initiative also promoted collaboration and knowledge translation between the participating stakeholders.
Methods: Potential COPD patients with co-morbidities were recruited from participating general practices. Following an initial needs assessment, the self-management programme is being tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The programme, based on constructs from the Health Belief Model, involves active engagement of patients with strategies aimed at enhancing their COPD knowledge, self-management capacity and skills in prioritisating multiple chronic conditions. Primary outcome of the study is assessment of patient knowledge, skills and self-management capacity of multiple chronic conditions using the Patient Activation Measure (PAM). Secondary outcome measures include COPD Knowledge Questionnaire, COPD Assessment Test, Multi-morbidity Illness Perceptions Scale, Morisky Medication Adherence Scale and accuracy of inhaler technique.
Findings: The study is currently in the phase of intervention delivery and follow-up. The average PAM score from baseline data of 49 participants (24 male and 25 female, mean age: 69.2) was 57.67, indicating lack of confidence and skill to modify health behaviour. Impact of the programme will be tested by comparing pre and post-test outcome measures after six months’ follow-up. Feasibility and sustainability will be evaluated by qualitative feedback from participating clinicians.
Implications: There has been good uptake of the programme by participating nurses following training workshops conducted by the researchers. We have faced challenges in practice recruitment and patient retention, mainly due to their co-morbidities. A first of its kind, our study could lead to improved long-term health outcomes, healthcare utilisation and patient-provider relationships. The study also broadens the practice nurse’s role in patient empowerment, which is vital given the surge in multi-morbidity worldwide.
Methods: Potential participants (N=40) will be identified from Sydney general practices based on: i) age between 40 - 84 years, ii) COPD diagnosis ≤ 24 months, iii) presence of one or more co-morbidity and iv) history of smoking. Following an initial needs assessment, the self-management intervention based on Health Belief Model will be tailored by trained practice nurses and delivered to patients in subsequent one-to-one sessions. The intervention framework, which includes constructs from renowned self-care models, will involve active engagement of patients with strategies towards enhancing their COPD knowledge, self-management capacity and prioritisation of multiple chronic conditions. Impact of the intervention will be measured by pre and post-test outcome measures covering activation, knowledge, beliefs and self-efficacy regarding COPD and multi-morbidity. After a 6-month follow-up period, feasibility and sustainability of the intervention will be evaluated by qualitative feedback from participating healthcare providers.
Relevance to policy, research and/or practice needs: No prior study has focused on improving self-efficacy of recently-diagnosed COPD patients with multi-morbidity. The project seeks to motivate these patients to actively manage their COPD while effectively balancing other chronic conditions, which will lead to improved long-term health outcomes, better healthcare utilisation and enhanced patient-provider relationships.
Methods: Participants were from a cohort of recently-diagnosed COPD patients in primary care with multi-morbidity. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis and a constructivist approach were used to interpret the data.
Results: Five core themes were induced regarding participants’ perspectives of COPD diagnosis. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Conclusion: This study is believed to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients’ perspectives in primary care.
Methods: Participants were identified from a cohort of primary care patients with multi-morbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from 9 male and 8 female participants aged between 40 and 85. Thematic analysis was performed and a constructivist approach used to interpret the data.
Principal findings: Five core themes were induced regarding participants' perspectives of COPD diagnosis and their co-morbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. In many cases, the salience of another chronic condition outweighed that of COPD. Self-management capacity and utilisation of healthcare services were challenged by limited understanding of the disease.
Implications: This study is thought to be a first in providing an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multi-morbidity. It highlights the need for tailored education and personalised management plans incorporating COPD patients' perspectives in primary care.
Aim of Study: This qualitative study was conducted to understand the physical, psychological and social impact of a new diagnosis of COPD in the context of multimorbidity.
Methods: Participants were diagnosed with COPD during a Sydney-based randomised control trial of case finding and early intervention in COPD. From 254 participants in the trial, 20 participants were identified for the qualitative study using maximum variation sampling based on age, gender, socio-economic status, geographic location and severity of COPD. Data was collected via semi-structured interviews and recorded for transcription purposes.
Results: In spite of accepting the diagnosis, most participants had difficulty recognising the significance and incorporating COPD into their lives. Self-management capacity and ability to use healthcare services were challenged by limited understanding of COPD and its implications, complications presented by comorbidities and financial barriers (eg. cost of consulting a specialist). In many cases, the salience of another chronic condition (eg. diabetes) outweighed that of COPD.
Conclusion: The findings provide an insight into how patients prioritise health conditions, highlighting the importance of understanding and incorporating their perspectives through patient-centered practice, tailored education and development of personalised care plans for COPD patients with multimorbidity.
Aims: This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.
Methods: Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective.
Results: Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities.
Conclusions: This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.