Clinical eHealth (Jan 2020)
REducing Delay through edUcation on eXacerbations (REDUX) in patients with COPD: a pilot study
Abstract
Early recognition of COPD exacerbations and prompt treatment could reduce recovery time, hospitalization risk and improve quality of life. We aimed to assess whether education of patients and healthcare providers could reduce the time between onset of COPD exacerbation symptoms and patient presentation in primary care. All the patients who were included in this REDUX pilot study received specific education about exacerbation management and a personalized action plan. Additional training about exacerbation management and training in how to educate patients was offered to the general practitioners and primary care nurses who were not experienced in giving this education. They received the REducing Delay through edUcation on eXacerbations (REDUX) training session, focusing on early recognition and treatment of COPD exacerbation symptoms. Outcomes were assessed of each patients exacerbation course before and after they received REDUX education. This included: (1) delay between exacerbation onset and recognition, (2) delay between recognition and action, (3) delay between recognition and consultation of GP. Wilcoxon Signed Rank tests were performed for the outcomes on delay. A total of 36 patients (female: 58%; mean age 70 [SD: 10.0]; mean FEV1%predicted: 51.3 [SD: 19.0]) were included. REDUX shortened days between onset of an exacerbation and recognition (from 7.7 to 2.9 days; mean gain: 4.8 days) [SD: 5.6], days between recognition and action (from 12.1 to 2.8 days; mean gain: 9.3 days) [SD: 10.5] and days between recognition and GP visit (from 11.5 to 3.2 days; mean gain: 8.3 days [SD: 11.2] (i.e. 72% decrease). The main reasons patients gave for the delay were “confusion with common cold” (68%), “don’t want to bother GP” (56%) and “trying to avoid oral steroids” (44%). We estimated that if REDUX could reduce hospital-treated COPD exacerbation recovery time by 2 days, Dutch national scale-up of REDUX could potentially save up to 33 million euros. Parallel, but apart from the REDUX study, the questions about the delay outcomes were included in a digital app for measurement of disease burden. This app was freely accessible during our REDUX study in the regular app stores as a support tool for self-management. Unfortunately, the fact that it was freely available meant that there was no check on the app's entered data. The data provided by the developer of the application showed that there were extreme differences in the days that were entered, and that it was not clear if the app was used by patients or healthcare providers who wanted to test the app. Therefore the results of the app were not usable for additional analysis to support our research. In conclusion the REDUX pilot program could successfully reduce the time between COPD exacerbation onset and patient presentation in primary care. Larger studies are required to confirm clinical effectiveness and cost-effectiveness both for the paper version of the program as for the digital application.
