Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher University, Rochester, NY, USA.
Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
BMC Pulm Med. 2023 Sep 23;23(1):358. doi: 10.1186/s12890-023-02651-w.
Transition from hospital to home is a vulnerable period for patients with COPD exacerbations, with a high risk for readmission and mortality. Twenty percent of patients with an initial hospitalization for a COPD exacerbation are readmitted to a hospital within 30 days, costing the health care system over $15 billion annually. While nebulizer therapy directed at some high-risk COPD patients may improve the transition from hospital to home, patient and social factors are likely to contribute to difficulties with their use. Current literature describing the COPD patient's experience with utilizing nebulizer therapy, particularly during care transitions, is limited. Therefore, the objective of this study was to explore underlying COPD patient and social factors contributing to practical difficulties with nebulizer use at the care transition from hospital to home.
This was a qualitative study conducted between September 2020 and June 2022. Patients were included if they were ≥ 40 years old, had a current diagnosis of COPD, had an inpatient admission at a hospital, and were discharged directly to home with nebulizer therapy. Semi-structured, one-on-one interviews with patients were conducted covering a broad range of patient and social factors and their relationships with nebulizer use and readmission. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using a mixed inductive and deductive approach.
Twenty-one interviews were conducted, and subjects had a mean age of 64 ± 8.4 years, 62% were female, and 76% were White. The predominant interview themes were health care system interactions and medication management. The interviews highlighted that discharge counseling methods and depth of counseling from hospitals were inconsistent and were not always patient-friendly. They also suggested that patients could appropriately identify, set up, and utilize their nebulizer treatment without difficulties, but additional patient education is required for nebulizer clean up and maintenance.
Our interviews suggest that there is room for improvement within the health care system for providing consistent, effective discharge counseling. Also, COPD patients discharged from a hospital on nebulizer therapy can access and understand their treatment but require additional education for nebulizer clean up and maintenance.
COPD 加重患者从医院到家庭的过渡时期是一个脆弱的时期，再入院和死亡的风险很高。20%因 COPD 加重初次住院的患者在 30 天内再次入院，每年给医疗保健系统造成超过 150 亿美元的费用。虽然针对一些高危 COPD 患者的雾化器治疗可能会改善从医院到家庭的过渡，但患者和社会因素可能会导致使用雾化器治疗存在困难。目前描述 COPD 患者在使用雾化器治疗方面的经验，特别是在护理过渡期间的经验有限。因此，本研究的目的是探讨导致 COPD 患者在从医院到家庭的护理过渡期间使用雾化器治疗存在实际困难的潜在患者和社会因素。
这是一项在 2020 年 9 月至 2022 年 6 月期间进行的定性研究。如果患者年龄≥40 岁、目前诊断为 COPD、在医院住院且直接出院回家接受雾化器治疗，则纳入患者。对患者进行半结构化、一对一的访谈，涵盖广泛的患者和社会因素及其与雾化器使用和再入院的关系。访谈进行了录音，并逐字记录。采用混合归纳和演绎的方法进行主题分析。
共进行了 21 次访谈，患者的平均年龄为 64±8.4 岁，62%为女性，76%为白人。主要访谈主题是医疗保健系统的相互作用和药物管理。访谈强调，医院的出院咨询方法和咨询深度不一致，并不总是以患者为中心。他们还表明，患者可以在没有困难的情况下适当地识别、设置和使用他们的雾化器治疗，但需要对雾化器的清洁和维护进行额外的患者教育。
我们的访谈表明，医疗保健系统在提供一致、有效的出院咨询方面还有改进的空间。此外，从医院出院接受雾化器治疗的 COPD 患者可以获得并理解他们的治疗，但需要对雾化器的清洁和维护进行额外的教育。
