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Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled
Vicki Johnson-Warrington1, Karen Rees2, Colin Gelder3
1Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
Summary
The Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD) did not significantly reduce 3-month readmissions for COPD patients. However, the program showed promise in improving patient self-care and potentially preventing 30-day readmissions.
Area of Science:
- Pulmonology and Respiratory Medicine
- Health Services Research
- Patient Self-Management Programs
Background:
- COPD exacerbations frequently lead to hospitalization and subsequent readmissions.
- Patients often lack adequate support post-discharge, contributing to readmission cycles.
- The Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD) was developed to address these post-discharge needs.
Purpose of the Study:
- To evaluate the effectiveness of the SPACE for COPD program in reducing hospital readmissions at 3 months post-discharge.
- To compare the SPACE for COPD intervention against usual care in a randomized trial.
Main Methods:
- A prospective, single-blinded, two-center randomized trial.
- Participants hospitalized for COPD exacerbation were randomized to either usual care or the SPACE for COPD program.
- Primary outcome: respiratory readmission at 3 months; secondary outcomes included quality of life and exercise capacity.
Main Results:
- No significant difference in 3-month readmission rates or mortality between the SPACE for COPD and usual care groups.
- A trend towards reduced 30-day readmissions in the intervention group (5 vs. 10 patients).
- Significant improvements in exercise tolerance and Chronic Respiratory Questionnaire scores for both groups, with some measures favoring the intervention group.
- Intervention group reported enhanced self-efficacy in managing COPD, recognizing warning signs, and adhering to medication regimens.
Conclusions:
- SPACE for COPD did not meet its primary endpoint of reducing 3-month readmissions compared to usual care.
- The program demonstrated positive effects on secondary outcomes, including patient-reported self-management capabilities.
- SPACE for COPD appears safe and may offer benefits in preventing short-term (30-day) readmissions for COPD patients.
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