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Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: a randomized trial.
Press, Valerie G; Arora, Vineet M; Shah, Lisa M; Lewis, Stephanie L; Charbeneau, Jeffery; Naureckas, Edward T; Krishnan, Jerry A.
Afiliação
  • Press VG; Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5000, W328, Chicago, IL 60637, USA. vpress@medicine.bsd.uchicago.edu
J Gen Intern Med ; 27(10): 1317-25, 2012 Oct.
Article em En | MEDLINE | ID: mdl-22592354
BACKGROUND: Hospitalized patients frequently misuse their respiratory inhalers, yet it is unclear what the most effective hospital-based educational intervention is for this population. OBJECTIVE: To compare two strategies for teaching inhaler use to hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A Phase-II randomized controlled clinical trial enrolled hospitalized adults with physician diagnosed asthma or COPD. PARTICIPANTS: Hospitalized adults (age 18 years or older) with asthma or COPD. INTERVENTIONS: Participants were randomized to brief intervention [BI]: single-set of verbal and written step-by-step instructions, or, teach-to-goal [TTG]: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back). MAIN MEASURES: The primary outcome was metered-dose inhaler (MDI) misuse post-intervention (<75% steps correct). Secondary outcomes included Diskus® misuse, self-reported inhaler technique confidence and prevalence of 30-day health-related events. KEY RESULTS: Of 80 eligible participants, fifty (63%) were enrolled (BI n=26, TTG n=24). While the majority of participants reported being confident with their inhaler technique (MDI 70%, Diskus® 94%), most misused their inhalers pre-intervention (MDI 62%, Diskus® 78%). Post-intervention MDI misuse was significantly lower after TTG vs. BI (12.5 vs. 46%, p=0.01). The results for Diskus® were similar and approached significance (25 vs. 80%, p=0.05). Participants with 30-day acute health-related events were less common in the group receiving TTG vs. BI (1 vs. 8, p=0.02). CONCLUSIONS: TTG appears to be more effective compared with BI. Patients over-estimate their inhaler technique, emphasizing the need for hospital-based interventions to correct inhaler misuse. Although TTG was associated with fewer post-hospitalization health-related events, larger, multi-centered studies are needed to evaluate the durability and clinical outcomes associated with this hospital-based education.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Participação do Paciente / Educação de Pacientes como Assunto / Doença Pulmonar Obstrutiva Crônica / Inaladores Dosimetrados / Hospitalização Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2012 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Participação do Paciente / Educação de Pacientes como Assunto / Doença Pulmonar Obstrutiva Crônica / Inaladores Dosimetrados / Hospitalização Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2012 Tipo de documento: Article