None listed
Conditions
Brief summary
Chronic obstructive pulmonary disease (COPD) is now considered a multisystem disease, in which comorbidities feature prominently. COPD guidelines recommend holistic assessment and management of relevant comorbid diseases but there is limited information as to how this is best achieved. This pilot study aimed to explore the views of stakeholders, including patients and the healthcare team, on the feasibility, acceptability and barriers to a collaborative, multidisciplinary team-based care intervention (TEAMcare) to improve health outcomes in COPD patients, within the context of a local hospital outpatient clinic.
Interventions
Collaborative, multidisciplinary care.
Subjects attended for follow up visits at five and ten months to ascertain clinical status, algorithm compliance and to review and revise management recommendations. The intervention was conducted using existing resources, involving collaboration with general practice and the publicly-funded local chronic disease management programme. Stakeholders provided qualitative feedback about the intervention in terms of feasibility, acceptability and barriers via st
Collaborative, multidisciplinary care. Subjects attended for follow up visits at five and ten months to ascertain clinical status, algorithm compliance and to review and revise management recommendations. The intervention was conducted using existing resources, involving collaboration with general practice and the publicly-funded local chronic disease management programme. Stakeholders provided qualitative feedback about the intervention in terms of feasibility, acceptability and barriers via structured and semi-structured interviews. All participants received the TEAMcare intervention, which will entail pulmonary rehabilitation (regarded as standard care for COPD management) integrated within individualised structured management plans prescribed by the Chief Investigator (Dr Belinda Cochrane, Staff Specialist Respiratory and Sleep Physician) following a comprehensive baseline (pre-test) assessment of COPD and prognostic factors (biological, psychological, and behavioural), exercise capacity (cardiorespiratory fitness and muscle strength) and functional health (health-related quality of life/disability). Pulmonary rehabilitation will be a modified version of the national Healthy Eating Activity and Lifestyle (HEAL 'Trademark') program currently being delivered by South Western Sydney Medicare Local Ltd. HEAL 'Trademark', which consists of eight weekly group education (1 hour weekly) and group exercise sessions (1 hour weekly, aerobic and resistance exercise instruction for the home by accredited exercise physiologists and dietitians) as well as individual assessments before and after the program, and at five and 12 months follow-up. Each week participants undertook one hour of supervised group-based low to moderate intensity physical activity followed by a one hour group-based healthy lifestyle and disease education class, including recommendations for achieving sustainable ideal changes in body weight for patients with COPD. The HEAL staff recorded participant attendance. A nurse case officer was assigned to work with the patient to co-ordinate the pulmonary rehabilitation and any individualised health services according to their management plan (e.g. access to mental health or other medical specialists; disease and end of life education; smoking cessation program). After an initial face-to-face contact session of 30-40 minutes, subsequent contacts were by weekly telephone sessions of 15-20 minutes each over the 10 week period. The nurse case officer would monitor symptoms monthly (breathlessness, depression and anxiety), and reinforce information provided by Chief Investigator about their individualised management plan, and address any difficulties with its implementation, taking into account patients’ needs and preferences and keep a TEAMcare log for adherence.
Sponsors
Western Sydney University
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Male or female patients aged 40 years or older with symptoms and spirometry consistent with moderate to severe COPD diagnosis, as defined by the GOLD criteria, who have given freely written informed consent will be eligible to participate, unless exclusion criteria are present
Exclusion criteria
Patients with symptoms of unstable angina, or heart attack within the previous 8 weeks at the time of screening, who have previously participated in a pulmonary rehabilitation program, unable to walk, and not proficient in English will be excluded
Outcome results
None listed