Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial

Beatrice Huang, Rachel Willard-Grace, Denise De Vore, Jessica Wolf, Chris Chirinos, Stephanie Tsao, Danielle Hessler, George Su, David H Thom, Beatrice Huang, Rachel Willard-Grace, Denise De Vore, Jessica Wolf, Chris Chirinos, Stephanie Tsao, Danielle Hessler, George Su, David H Thom

Abstract

Background: Chronic obstructive pulmonary disease (COPD) severely hinders quality of life for those affected and is costly to the health care system. Care gaps in areas such as pharmacotherapy, inhaler technique, and knowledge of disease are prevalent, particularly for vulnerable populations served by community clinics. Non-professionally licensed health coaches have been shown to be an effective and cost-efficient solution in bridging care gaps and facilitating self-management for patients with other chronic diseases, but no research to date has explored their efficacy in improving care for people living with COPD.

Method: This is multi-site, single blinded, randomized controlled trial evaluates the efficacy of health coaches to facilitate patient self-management of disease and improve quality of life for patients with moderate to severe COPD. Spirometry, survey, and an exercise capacity test are conducted at baseline and at 9 months. A short survey is administered by phone at 3 and 6 months post-enrollment. The nine month health coaching intervention focuses on enhancing disease understanding and symptom awareness, improving use of inhalers; making personalized plans to increase physical activity, smoking cessation, or otherwise improve disease management; and facilitating care coordination.

Discussion: The results of this study will provide evidence regarding the efficacy and feasibility of health coaching to improve self-management and quality of life for urban underserved patients with moderate to severe COPD.

Trial registration: ClinicalTrials.gov identifier NCT02234284 . Registered 12 August 2014.

Keywords: Chronic obstructive pulmonary disease; Health coaching; Quality of life.

Figures

Fig. 1
Fig. 1
Study workflow from identification to enrollment
Fig. 2
Fig. 2
Participant timeline

References

    1. CDC - COPD Home Page - Chronic Obstructive Pulmonary Disease (COPD) (2016). Accessed 24 Apr 2017.
    1. Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. Total and State-Specific Medical and Absenteeism Costs of COPD Among Adults Aged 18 years in the United States for 2010 and Projections Through 2020. Chest. 2015
    1. Make B, Dutro MP, Paulose-Ram R, Marton JP, Mapel DW. Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients. Int J Chron Obstruct Pulmon Dis. 2012
    1. Sandhu SK, Chu J, Yurkovich M, Harriman D, Taraboanta C, FitzGerald JM. Variations in the management of acute exacerbations of chronic obstructive pulmonary disease. Can Respir J. 2013
    1. Diette GB, Orr P, McCormack MC, Gandy W, Hamar B. Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines? Popul Health Manag. 2010
    1. Melzer AC, Ghassemieh BJ, Gillespie SE, Lindenauer PK, McBurnie MA, Mularski RA, Naureckas ET, Vollmer WM, Au DH. Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD. Respir Med. 2017
    1. Pothirat C, Liwsrisakun C, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A. Comparative study on health care utilization and hospital outcomes of severe acute exacerbation of chronic obstructive pulmonary disease managed by pulmonologists vs internists. Int J Chron Obstruct Pulmon Dis. 2015
    1. Fromer L. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. Int J Chron Obstruct Pulmon Dis. 2011
    1. Ortiz G, Fromer L. Patient-Centered Medical Home in chronic obstructive pulmonary disease. J. Multidiscip. Healthc. 2011
    1. Willard-Grace R, Chen EH, Hessler D, De Vore D, Prado C, Bodenheimer T, Thom DH. Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial. Ann Fam Med. 2015
    1. Linden A, Butterworth SW, Prochaska JO. Motivational interviewing-based health coaching as a chronic care intervention. J Eval Clin Pract. 2010
    1. Benzo R, Vickers K, Novotny PJ, Tucker S, Hoult J, Neuenfeldt P, Connett J, Lorig K, McEvoy C. Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study. Am J Respir Crit Care Med. 2016
    1. Rice KL, Dewan N, Bloomfield HE, Grill J, Schult TM, Nelson DB, Kumari S, Thomas M, Geist LJ, Beaner C, Caldwell M, Niewoehner DE. Disease management program for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010
    1. Wood-Baker R, Reid D, Robinson A, Walters EH. Clinical trial of community nurse mentoring to improve self-management in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2012
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. doi: 10.1016/j.jbi.2008.08.010.
    1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease – GOLD. (2017). Accessed 01 May 2017.
    1. ATS Statement Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2002
    1. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB. The 6-min walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132:919–23.
    1. Tsai CL, Hodder RV, Page JH, Cydulka RK, Rowe BH, Camargo CA. The short-form chronic respiratory disease questionnaire was a valid, reliable, and responsive quality-of-life instrument in acute exacerbations of chronic obstructive pulmonary disease. J Clin Epidemiol. 2008
    1. Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care. 2006
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Leidy NK. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009
    1. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW, Karagiannis K, Siafakas N, Tzanakis N. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) BMC Pulm Med. 2012
    1. Goetz K, Freund T, Gensichen J, Miksch A, Szecsenyi J, Steinhaeuser J. Adaptation and Psychometric Properties of the PACIC Short Form. Am J Manag Care. 2012;18:55–60.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001
    1. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Arch Intern Med. 2006
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74. doi: 10.1097/00005650-198601000-00007.
    1. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. J Clin Hypertens. 2008;10:348–54. doi: 10.1111/j.1751-7176.2008.07572.x.
    1. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990
    1. Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37:510–7. doi: 10.1097/00005650-199905000-00010.
    1. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, VanRyn M. Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population. J Gen Intern Med. 2008
    1. Melani AS, Canessa P, Coloretti I, DeAngelis G, DeTullio R, Del Donn M, Giacobbe R, Scarlato I, Serafini A, Barbato N, Vaghi A, Sestini P, Educational Study Group of the Italian Association of Hospital Pulmonologists (AIPO) Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use. Respir Med. 2012

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