Activating primary care COPD patients with multi-morbidity (APCOM) pilot project: study protocol

Abstract

Chronic obstructive pulmonary disease (COPD), third leading cause of mortality worldwide,1 is primarily caused by cigarette smoking in Australia.2 COPD often occurs in the presence of multi-morbidity, which is the simultaneous occurrence of two or more chronic conditions; this is a growing concern in a health system focused on single-disease management.3 Around 80% of older Australians have multi-morbidity, average prevalence of chronic respiratory disease being 9.5%.4 A systematic review of COPD education programs suggests that equipping patients with self-management skills is as important as disease knowledge.5 Studies exploring positive effects of chronic disease-management interventions6 also underline the lack of studies aimed at empowering patients. Although a recent Cochrane Review7 of COPD self-management interventions shows increased health-related quality of life and decreased probability of respiratory-related hospitalisation, similar interventions have not been consistently effective when applied in recent trials.8-10 Though interventions aimed at modifying COPD-related health behaviour have great potential, extant literature points to need for self-management programs in primary care. There is a dearth of interventions involving patients with multimorbidity, clinicians and other stakeholders, that can be generalisable to other populations.11 Patients with multimorbidity are often excluded from chronic disease-management trials; a Cochrane review12 of multi-morbidity interventions found only ten such studies. Our recent qualitative study,13 which explored the impact of COPD diagnosis in primary care patients with co-morbidities (co-existing chronic conditions), found suboptimal disease understanding and health-care utilisation. The above evidence demonstrates a need for development and testing interventions to increase self-management capacity in COPD patients with co-morbidities. Even a brief education session is effective in improving disease knowledge and response to symptoms;14 as demonstrated by selfmanagement interventions10, 15 on COPD which increased patient self-efficacy. Such programs do not only improve health status and prevent hospital remissions,16 but also lead to better patientprovider relationships, self-efficacy and sense of identity.17 With no prior study having seemed to focus on improving self-efficacy of COPD patients with co-morbidities in primary care, our study aims to empower these patients by trialling a tailored, practice nurse -delivered self-management program. AIMS This pre and post-test pilot study aims to trial the impact and feasibility of a tailored self-management program for primary care COPD patients with multi-morbidity. Our hypothesis is that at six months\u27 follow-up, participants would have: 1. Better activation in terms of their COPD-related health behaviour. 2. Improved knowledge and self-management capacity of COPD. 3. Increased self-efficacy in terms of their overall health behaviours. METHODS This pilot study is funded by GlaxoSmithKline Australia and recognised by the National Health and Medical Research Council through a scholarship to S.A. The study has approval from the Human Research Ethics Committee of UNSW Australia (HREC14139)