Effects of written action plan adherence on COPD exacerbation recovery

• Published in: Thorax Vol. 66; no. 1; pp. 26 - 31
• Main Authors: Bischoff, Erik W M A, Hamd, Dina H, Sedeno, Maria, Benedetti, Andrea, Schermer, Tjard R J, Bernard, Sarah, Maltais, François, Bourbeau, Jean
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.01.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Antibiotics; Biological and medical sciences; Canada; Cardiology. Vascular system; chronic obstructive; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical outcomes; Clinical trials; COPD exacerbations; Delivery of Health Care - utilization; disease management; Drug Administration Schedule; Drug Prescriptions - standards; Drug Therapy, Combination; Dyspnea; Emergency medical care; Female; Fitness training programs; Glucocorticoids - administration & dosage; Health services utilization; Hospitals; Humans; Male; Medical sciences; Middle Aged; Patient admissions; Patient Care Planning; Patient Compliance; Patient Education as Topic - methods; Patient Education as Topic - standards; Pneumology; Prednisone - therapeutic use; Prospective Studies; Pulmonary disease; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - therapy; Self Care - methods; Self Care - standards; Time Factors; Variables; Canada; Lung disease; Action; Chronic; Respiratory disease; Bronchus disease; Anesthesia; Chronic obstructive pulmonary disease; Circulatory system; Obstructive pulmonary disease; Cardiology; Adhesion; Recovery
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2009.127621

BackgroundThe effects of written action plans on recovery from exacerbations of chronic obstructive pulmonary disease (COPD) have not been well studied. The aims of this study were to assess the effects of adherence to a written action plan on exacerbation recovery time and unscheduled healthcare utilisation and to explore factors associated with action plan adherence.MethodsThis was a 1-year prospective cohort study embedded in a randomised controlled trial. Exacerbation data were recorded for 252 patients with COPD who received a written action plan for prompt treatment of exacerbations with the instructions to initiate standing prescriptions for both antibiotics and prednisone within 3 days of exacerbation onset. Following the instructions was defined as adherence to the action plan.ResultsFrom the 288 exacerbations reported by 143 patients, start dates of antibiotics or prednisone were provided in 217 exacerbations reported by 119 patients (53.8% male, mean age 65.4 years, post-bronchodilator forced expiratory volume in 1 s (FEV1) 43.9% predicted). In 40.1% of exacerbations, patients adhered to their written action plan. Adherence reduced exacerbation recovery time with statistical (p=0.0001) and clinical (−5.8 days) significance, but did not affect unscheduled healthcare utilisation (OR 0.94, 95% CI 0.49 to 1.83). Factors associated with an increased likelihood of adherence were influenza vaccination, cardiac comorbidity, younger age and lower FEV1 as percentage predicted.ConclusionsThis study shows that adherence to a written action plan is associated with a reduction in exacerbation recovery time by prompt treatment. Knowing the factors that are associated with proper and prompt utilisation of an action plan permits healthcare professionals to better focus their self-management support on appropriate patients.