Does adherence to exacerbation action plans matter? Insights from two COPD self-management studies
Jade Schrijver,
Tanja Effing,
Joanke van Helden,
Job van der Palen,
Paul van der Valk,
Marjolein Brusse-Keizer,
Anke Lenferink
Affiliations
Jade Schrijver
Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands; Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Corresponding author. Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands.
Tanja Effing
College of Medicine and Public Health, Flinders University, Adelaide, Australia; School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Joanke van Helden
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
Job van der Palen
Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
Paul van der Valk
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
Marjolein Brusse-Keizer
Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
Anke Lenferink
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
Introduction: Patients' adherence is essential for COPD self-management, as beneficial effects can only be expected in adherent patients. We explored associations between patients’ adherence to COPD exacerbation action plans and health outcomes. Materials and methods: Pooled COPD self-treatment intervention group data from two RCTs were analysed, only including patients who had ≥1 COPD exacerbation or started ≥1 course of oral corticosteroids over one-year follow-up. Optimal adherence was defined as ‘self-treatment initiated ≤1 day before or after exacerbation start’, suboptimal adherence as ‘self-treatment initiated 2 days before or after exacerbation start or no self-treatment initiated for a short (1–3 days) exacerbation’, and significant delay or no treatment as ‘self-treatment initiated >2 days after exacerbation start or no self-treatment initiated for a longer (>3 days) exacerbation’. Regression models were built for several health outcomes, with the number of COPD exacerbation days/patient/year being the primary outcome. Results: Patients with significant delay or no treatment (n = 46) had more exacerbation days/patient/year (33.3 (95 % CI 10.9; 55.6)) than optimal adherent patients (n = 38) (23.7 (95 % CI 1.7; 45.7)). The duration per COPD exacerbation was longer for patients with significant delay or no treatment (15.5 days) compared to optimal adherent patients (7.8 days). No differences in health outcomes were observed between optimal and suboptimal adherent patients. Conclusions: Being adherent to action plans is associated with better health outcomes than significant delayed treatment or no treatment at all. Interestingly, suboptimal adherence demonstrated health benefits comparable to optimal adherence. COPD self-management interventions should prioritise strategies to optimise patients’ adherence to action plans.
