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IIR 14-060 – HSR&D Study

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IIR 14-060
Understanding Patient Management of COPD Exacerbations
Vincent S. Fan MD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: May 2016 - April 2020

BACKGROUND/RATIONALE:
Prompt treatment of chronic obstructive pulmonary disease (COPD) exacerbations can decrease the severity and duration of exacerbations and may reduce the risk of COPD hospitalizations. This study will examine Veterans' care-seeking behaviors focusing on Veterans perceived need for care and perceived access to care and how these factors delay seeking care for COPD exacerbations.

OBJECTIVE(S):
The Specific Aims are: 1) Examine the barriers to seeking care for COPD exacerbations or worsening breathing; 2) Test the use of a real-time remote inhaler monitor to identify early exacerbations.

METHODS:
We will enroll up to 600 participants at VA Puget Sound and the VA Eastern Colorado. Approximately 60 participants who reported a COPD exacerbation and were either hospitalized, treated in the emergency department, treated as outpatients, or did not seek treatment will participate in a 45 minute in-depth semi-structured phone interview by a trained research staff to understand how they responded to worsening symptoms and decided whether to seek care. When available, the informal caregivers for these Veterans will be interviewed to obtain their perspective on the exacerbation event.

Participants will attend one in-person baseline visit to complete spirometry and baseline questionnaires. Participants will be contacted every 2 weeks for 1 year using an interactive voice response system that will screen for COPD exacerbations with 4 yes/no questions. Participants with a positive screen will be called by research staff to obtain additional detailed information on the exacerbation and how it was treated. Data analysis will examine whether access to care and baseline factors are associated with a delay in treatment.

In Aim 2, 200 participants from Aim 1 will use an inhaler sensor with their albuterol inhaler, which will transmit data in real-time about their daily inhaler use. They will use this sensor for the 12-month follow-up period. Data analysis will measure ability of a change in albuterol use to predict patient reported COPD exacerbations to determine the appropriate cut-offs that can be used in a future intervention trial.

FINDINGS/RESULTS:
The study was approved by the VA Puget Sound IRB with a start date of May 1, 2016. Recruitment began in September, 2016 and is ongoing. No findings at this time since active enrollment ongoing.

IMPACT:
COPD is a common chronic condition among Veterans. Patients with COPD experience frequent exacerbations that can lead to hospitalizations and emergency department visits, which may contribute to worse quality of life and disease progression. Timely treatment of exacerbations is needed to decrease the severity and duration of exacerbations and reduce the number of hospitalizations. It is important to understand the patient experience surrounding a COPD exacerbation to understand how to reduce delay between the onset of symptoms and treatment. Better understanding of patient perception of symptoms and need for care, patient perception of access to care, and the contextual factors (e.g. social support, prior exacerbations) is needed to inform the VA health care system to provide timely evaluation for exacerbations among COPD patients.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Health Systems, Lung Disorders
DRE: Treatment - Observational
Keywords: Adherence, Attitudes/Beliefs, Outcomes - Patient, Telemedicine/Telehealth
MeSH Terms: none