COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study

Background There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. Methods We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Quebec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPD patients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. Results Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; >= 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean +/- standard deviation: 68 +/- 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). Conclusions Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits.