Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project.

MacNab, Michele; Lee, Siew Hwa; McCloughan, Lucy; Hanley, Janet; McKinstry, Brian; Pinnock, Hilary

Abstract

Background - Pulse oximetry could potentially contribute to self-monitoring. NHS Lothian's 'Light Touch' service provided COPD patients with a self-management plan based on symptoms and oximetry. The service was overseen (though not actively monitored) by respiratory-trained community teams who were contactable by a telephone helpline. We aimed to assess the feasibility, perceived utility and impact of the 'Light Touch' service. Methods - A before-and-after assessment of St George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS) and use of healthcare resources during the 6-month feasibility study compared to the previous corresponding 6-months. Paired semi-structured interviews with patients at baseline and 6-months, interviews with managers and a focus group of professionals explored perceptions of the service and self-management. Transcripts were coded, and analysed thematically. Results - We recruited 51 participants (mean age 69.7 years (SD 8.4); 21 (46 %) male). 46 participants completed quantitative follow up (2 died, 2 were unwell, 1 refused). SGRQ: 21 (46 %) participants improved by 4 or more (the minimum important difference); 12 (26 %) deteriorated by 4 or more. HADS: more participants had normal scores for anxiety (65 %) and depression (80 %) at 6-months than at baseline (51 and 64 %). More emergency therapy was prescribed during the study period compared to the previous year. Only 18 participants (39 %) contacted the Light Touch Helpline during the 6-month study. Twenty patients provided a total of 36 interviews, 8 clinicians contributed to a focus group and 6 managers were interviewed. Patients considered that the oximetry readings heightened awareness of their condition and gave them confidence to make self-management decisions. Healthcare professionals valued oximetry as a tool for teaching people self-management skills, but were concerned that patients rarely contacted the teams for help or advice during the study. Conclusions - 'Light Touch' shows promise as a low-cost strategy for empowering patients' self-management skills and reducing reliance on clinical supervision.

Citation

MACNAB, M., LEE, S.H., MCCLOUGHAN, L., HANLEY, J., MCKINSTRY, B. and PINNOCK, H. 2015. Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project. BMC health services research [online], 15, article number 485. Available from: https://doi.org/10.1186/s12913-015-1135-2

• Journal Article Type: Article
• Acceptance Date: Oct 9, 2015
• Online Publication Date: Oct 26, 2015
• Publication Date: Dec 31, 2015
• Deposit Date: Sep 14, 2016
• Publicly Available Date: Sep 14, 2016
• Journal: BMC health services research
• Electronic ISSN: 1472-6963
• Publisher: Springer
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Article Number: 485
• DOI: https://doi.org/10.1186/s12913-015-1135-2
• Keywords: Chronic obstructive pulmonary disease (COPD); Self management; Tele monitoring; Primary care; Delivery of care
• Public URL: http://hdl.handle.net/10059/1677
• Contract Date: Sep 14, 2016