Acceptance of home support and integrated care among advanced COPD patients who live outside large medical centers.

BACKGROUND: Poor self-management constitutes a risk factor for COPD deterioration. Patients from rural areas located at a considerable distance from large medical centers frequently need home-support in advanced stages of the disease. Integrated care has been proposed as a comprehensive model for appropriate treatment, coordination and holistic support. The aim of the study was to assess whether home visits provided by trained assistants are needed and accepted by advanced COPD patients living in rural areas a to evaluate whether an individual short educational program can actually improve such patients' knowledge of COPD and inhaler use. METHODS: Thirty patients with severe or very severe but stable COPD participated in one-month home-assistance interventions twice a week. RESULTS: The total value ≥70 of SGRQ (St George's Respiratory Questionnaire) was recorded in 18 (60%) patients. At the beginning of the study, the patients' knowledge of COPD and inhalation techniques was highly unsatisfactory. Significant improvement in all items (p=0.00) was obtained after the intervention. The risk for poor self-management was high. All patients had at least one 'factor' that indicated the need for home-support. A total of 240 visits (100%) were completed. Patients expressed high acceptance for home-based support delivered by medical assistants twice a week for one month. No patients opposed this kind of care and most of them expressed interest in receiving it in the future. CONCLUSIONS: The results suggest a compelling need for home care and demonstrate full acceptance of this kind of support on the part of advanced COPD patients.

[Quality of life of patients with asthma which has been well and poorly controlled]. / Jakosc zycia chorych na astme dobrze i zle kontrolowana.

INTRODUCTION: The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled. MATERIAL AND METHODS: 70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdansk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica. RESULTS: According to GINA in 26 patients mild asthma was diagnosed, in 31 - moderated and in 13 - severe disease. 41 patients were assessed as well controlled and 29 - as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was - 74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively. CONCLUSIONS: Quality of life is strongly dependent on the control of symptoms in asthmatic patients.