Article type
Year
Abstract
Background: Well-produced evidence-based patient education resources could lead patients to discuss the appropriateness of disease management with doctors. This could result in a shift towards treatments with proven efficacy. COPD (chronic obstructive pulmonary disease) is managed inconsistently in spite of evidence-based guidelines for clinicians. For this study, we produced a patient resource. Talking to your doctor about COPD, with extensive input from patients and a range of health professionals. The resource summarises Cochrane reviews in very plain English, and suggests questions which patients can ask their doctors to prompt consideration of evidence. We are conducting a trial of the resource and present results at 3 months.
Objectives: We hypothesised that the resource would improve COPD management. We also expected improved quality of life (mastery), satisfaction with information, communication with doctor and anxiety. We also measured implementation processes.
Methods: The trial compares two geographically separate groups to minimise contamination. Two hundred and forty nine patients with moderate to severe COPD were recruited. Measures were taken at baseline and 3 months. Control participants received a standard leaflet about COPD. The primary outcome was measured using rates of influenza vaccination and bone density testing as indicators. Other measures used existing published scales. Process measures were included at 3 months.
Results: Groups were similar at baseline except in average socioeconomic disadvantage (p < 0.001). Further analysis showed effect modification by this variable. The table on the following page, shows outcome measures stratified by median split of socioeconomic disadvantage index. Process measures showed high levels of personal use of the resource, greater than for the control leaflet. However, less than half of intervention participants raised issues with doctors and very few changed treatments.
Conclusions: We have shown that a patient education resource about evidence for COPD treatments, produced according to current best practice, did not appear to improve health outcomes within 3 months. Process measures suggest that barriers may be found in doctor/patient communication practices. While more patient information may be produced about evidence, improved implementation may not automatically follow. If implementation of evidence is an objective, barriers should be identified and addressed during the design of interventions.
Objectives: We hypothesised that the resource would improve COPD management. We also expected improved quality of life (mastery), satisfaction with information, communication with doctor and anxiety. We also measured implementation processes.
Methods: The trial compares two geographically separate groups to minimise contamination. Two hundred and forty nine patients with moderate to severe COPD were recruited. Measures were taken at baseline and 3 months. Control participants received a standard leaflet about COPD. The primary outcome was measured using rates of influenza vaccination and bone density testing as indicators. Other measures used existing published scales. Process measures were included at 3 months.
Results: Groups were similar at baseline except in average socioeconomic disadvantage (p < 0.001). Further analysis showed effect modification by this variable. The table on the following page, shows outcome measures stratified by median split of socioeconomic disadvantage index. Process measures showed high levels of personal use of the resource, greater than for the control leaflet. However, less than half of intervention participants raised issues with doctors and very few changed treatments.
Conclusions: We have shown that a patient education resource about evidence for COPD treatments, produced according to current best practice, did not appear to improve health outcomes within 3 months. Process measures suggest that barriers may be found in doctor/patient communication practices. While more patient information may be produced about evidence, improved implementation may not automatically follow. If implementation of evidence is an objective, barriers should be identified and addressed during the design of interventions.