Thomas Rachel M, Locke Emily R, Woo Deborah M, Nguyen Ethan H K, Press Valerie G, Layouni Troy A, Trittschuh Emily H, Reiber Gayle E, Fan Vincent S
Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
Health Services Research and Development Service, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care.
Respir Care. 2017 Nov;62(11):1412-1422. doi: 10.4187/respcare.05445. Epub 2017 Jul 18.
COPD is common, and inhaled medications can reduce the risk of exacerbations. Incorrect inhaler use is also common and may lead to worse symptoms and increased exacerbations. We examined whether inhaler training could be delivered using Internet-based home videoconferencing and its effect on inhaler technique, self-efficacy, quality of life, and adherence.
In this pre-post pilot study, participants with COPD had 3 monthly Internet-based home videoconference visits with a pharmacist who provided inhaler training using teach-to-goal methodology. Participants completed mailed questionnaires to ascertain COPD severity, self-efficacy, health literacy, quality of life, adherence, and satisfaction with the intervention.
A total of 41 participants completed at least one, and 38 completed all 3 home videoconference visits. During each visit, technique improved for all inhalers, with significant improvements for the albuterol metered-dose inhaler, budesonide/formoterol metered-dose inhaler, and tiotropium dry powder inhaler. Improved technique was sustained for nearly all inhalers at 1 and 2 months. Quality of life measured with the Chronic Respiratory Questionnaire improved following the training: dyspnea (+0.3 points, = .01), fatigue (+0.6 points, < .001), emotional function (+0.5 points, = .001), and mastery (+0.7 points, < .001). Coping skills measured with the Seattle Obstructive Lung Disease Questionnaire improved (+9.9 points, = .003). Participants reported increased confidence in inhaler use; for example, mean self-efficacy for using albuterol increased 3 points ( < .001). Inhaler adherence improved significantly after the intervention from 1.6 at the initial visit to 1.1 at month 2 ( = .045). The pharmacist reported technical issues in 64% of visits.
Inhaler training using teach-to-goal methodology delivered by home videoconference is a promising means to provide training to patients with COPD that can improve technique, quality of life, self-efficacy, and adherence.
慢性阻塞性肺疾病（COPD）很常见，吸入药物可降低急性加重的风险。吸入器使用不当也很常见，可能导致症状加重和急性加重次数增加。我们研究了是否可以通过基于互联网的家庭视频会议提供吸入器培训，以及其对吸入技术、自我效能感、生活质量和依从性的影响。
在这项前后对照的试点研究中，患有COPD的参与者每月与一名药剂师进行3次基于互联网的家庭视频会议，该药剂师使用目标导向教学法提供吸入器培训。参与者完成邮寄问卷，以确定COPD严重程度、自我效能感、健康素养、生活质量、依从性以及对干预措施的满意度。
共有41名参与者完成了至少一次，38名完成了全部3次家庭视频会议。在每次会议期间，所有吸入器的技术都有所改善，沙丁胺醇定量气雾剂、布地奈德/福莫特罗定量气雾剂和噻托溴铵干粉吸入器有显著改善。几乎所有吸入器在1个月和2个月时技术改善情况得以维持。使用慢性呼吸问卷测量的生活质量在培训后有所改善：呼吸困难（+0.3分，P = 0.01）、疲劳（+0.6分，P < 0.001）、情绪功能（+0.5分，P = 0.001）和掌控感（+0.7分，P < 0.001）。使用西雅图阻塞性肺病问卷测量的应对技能有所改善（+9.9分，P = 0.003）。参与者报告使用吸入器的信心增加；例如，使用沙丁胺醇的平均自我效能感增加了3分（P < 0.001）。干预后吸入器依从性显著提高，从初次就诊时的1.6提高到第2个月时的1.1（P = 0.045）。药剂师报告64%的会议存在技术问题。
通过家庭视频会议采用目标导向教学法进行吸入器培训，是为COPD患者提供培训的一种有前景的方法，可改善技术、生活质量、自我效能感和依从性。
