Chronic Obstructive Pulmonary Disease, Heart Failure, Medication Adherence, Self-care
Conditions
Keywords
Patient participation, Empowerment, Medication management, Symptom management, Self determination theory, Motivational Interviewing
Brief summary
This study evaluates if motivational interviewing sessions aiming to motivate recently discharged patients with either chronic obstructive pulmonary disease or congestive heart failure to be active in post-discharge self-management can reduce re-hospitalization rates.
Detailed description
Included patients transition to home will be bridged through a telephone-call from a patient activation coach two days post-discharge. The patients will thereafter get motivational interviewing sessions by the same patient activation coach with the the goal that the patients are motivated to the knowledge, skills and confidence needed to manage the four main activity areas: 1) medication management; 2) adhere to care plan/ follow-up visits according to the discharge plan; 3) recognize indications (symptoms/signs) that the condition is worsening and how to respond; and 4) contact and manage relations/encounters with health care providers. Patients in control group will receive standard care, i.e. discharge and follow-up as in normal procedures. The investigators will use a randomization in permuted blocks of 10 intervention patients and 10 control patients included. To test the hypothesis that the re-hospitalizations rate is 15 % lower in the intervention group compared to the control group 242 patients (121 per group) are needed for power of 80% with the level of significance set to 5 % using two-sided chi-square.
Interventions
BEHAVIORALMotivational Interviewing
Patients will get motivational interviewing sessions by a patient activation coach (medical social workers and/or nurses trained in motivational interviewing and in the intervention) in five post hospital discharge sessions (whereof one face-to-face, four by phone) aiming to increase patient motivation to become active in self-management (medication management, care plan/follow-up, symptoms/signs of worsening condition, contacts with health care provider).
Sponsors
Vårdalstiftelsen
Forte
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure admitted at a short-term medical ward and who are living in their private home.
Exclusion criteria
* Diagnoses of dementia or cognitive impairment, and need of interpreter to participate in conversations. The
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Re-hospitalization | 90 days | Registry data from the Swedish Register for Health Care Encounters |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Medication adherence | 30, 90 and 180 days | Patient reported data using the Morisky Medication Adherence Scale, 8 items, and registry data using medicine data from the Swedish Prescribed Drug Registry |
| Patient activation | 30, 90 and 180 days | Patient reported data using the Patient Activation Measure, 13 item |
| Healthcare usage | 30, 90 and 180 days | Registry data from the Swedish Register for Health Care Encounters: re-hospitalization at 30 and 180 days. Emergency room and primary care visits at 30, 90 and 180 days |
| Basic Psychological Needs | 30, 90 and 180 days | Patient reported data using the the Basic Psychological Need Satisfaction & Frustration Scale, 18 items |
| Depression | 30, 90 and 180 days | Patient reported data using PHQ-9 (Patient Health Questionnaire) |
| Health related quality of life | 30, 90 and 180 days | Patient reported data using the EQ-5D-5L |
Countries
Sweden
Outcome results
None listed