Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Int J Chron Obstruct Pulmon Dis. 2022 Jul 26;17:1651-1669. doi: 10.2147/COPD.S358426. eCollection 2022.
After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence - including but not limited to patients' perspective - and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.
在因急性 COPD 恶化而住院后,患者可管理的行为会影响再次住院的频率。本研究的目的是开发一种基于医院病房启动的行为改变轮(BCW)的干预措施,针对患者的关键健康行为,旨在提高生活质量并降低再次住院的频率。干预措施的制定由苏黎世大学医院的工作组进行,并遵循 BCW 的三个阶段,针对三个关键文献确定的问题:恶化管理不足、缺乏身体活动和持续吸烟。在第一阶段,通过分析已发表的证据 - 包括但不限于患者的观点 - 和卫生专业人员对这些问题的看法,我们确定了六个目标行为。在第二阶段,我们确定了六个相应的干预功能。作为我们的政策类别,我们选择制定指南和提供服务。在第三阶段,我们使用 46 种行为改变技术在我们的基本干预中定义了十八个基本干预包。交付模式将是面对面和电话联系。在住院期间,这种行为干预将由多专业团队提供。在出院后的至少 3 个月内,高级护理实践团队将通过电话继续并协调必要的护理包。该干预措施嵌入在更广泛的自我管理干预中,辅以综合护理组件。BCW 是开发我们 COPD 干预措施的有前途的基础。在未来,还将评估治疗护理团队-患者关系以及行为干预的提供之间的相互作用。