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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

Authors

Michele MacNab

Siew Hwa Lee

Lucy McCloughan

Janet Hanley

Brian McKinstry

Hilary Pinnock



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.

Journal Article Type Article
Publication Date Oct 26, 2015
Journal BMC health services research
Electronic ISSN 1472-6963
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
Volume 15
Article Number 485
Institution 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
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

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