Because of recent efforts to improve safe transitions from hospital to home, ensuring quality care for patients hospitalized with asthma and COPD has become a priority. A critical factor for safe care transitions may be improving patient selfmanagement skills prior to discharge. However, the most effective intervention to provide selfmanagement skills, particularly for addressing inhaler misuse in the hospital setting, is unknown. The primary objective of the study was to test the comparative effectiveness of two interventions that provide hospitalbased education on effective inhaler technique for hospitalized patient with asthma or COPD.
Adult patients with asthma or COPD were randomized to receive either teachtogoal (TTG) or brief intervention (BI) education. Patients receiving TTG were provided with a demonstration on inhaler technique and verbal and written instructions. Patients were then asked to redemonstrate their technique (i.e., “teachback”); this cycle continued until they demonstrated mastery (up to two rounds). Patients receiving BI education received verbal and written instructions. Use of metered dose inhaler (MDI) and Diskus® devices was assessed using detailed checklists. Misuse was defined as <75% of steps correct. Hospital followup data were collected at 30day postdischarge (phone interviews). Overall utilization of healthrelated services was assessed: serious events were defined as ED visits, hospitalizations, and/or deaths posthospital discharge. Chisquared, Fisher’s exact, and ttests were performed using STATA 11.
Fifty participants were enrolled and randomized to TTG (n = 24) or BI (n = 26). Participants had high baseline rates of inhaler misuse (MDI 76%; Diskus 78%). The proportion who misused MDIs postintervention decreased significantly for both TTG and BI groups (p < 0.05). However, there was a significantly greater reduction in the prevalence of misuse in the TTG group compared to the BI group (50% vs 30%, p = 0.01). There was also a nearly significant decrease in misuse for Diskus in the TTG versus BI group (p = 0.05). Thirtynine (78%) of participants had 30day followup data; there were three deaths, and 36 completed the followup interview (77% BI, 79% TTG). There were significantly more serious events in the BI group versus TTG at 30day postdischarge (p = 0.02).
Our study shows that providing hospitalbased instructions on inhaler technique for patients hospitalized with asthma and COPD can decrease prevalence of inhaler misuse prior to hospital discharge. Further, we demonstrate that TTG may be a superior strategy for improving inhaler technique and may lead to improved clinical outcomes compared to BI. Larger, multiinstitution comparative studies are needed to evaluate the effects of TTG versus BI for different patient subgroups (e.g., level of health literacy), the durability of hospitalbased education after discharge, and the costeffectiveness and implications on clinical outcomes of the two interventions.
To cite this abstract:Naureckas E, Charbeneau J, Krishnan J, Shah L, Lewis S, Press V, Arora V. Comparative Effectiveness of Hospitalbased Educational Interventions for Patients with Asthma or Copd. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97561. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/comparative-effectiveness-of-hospitalbased-educational-interventions-for-patients-with-asthma-or-copd/. Accessed September 17, 2019.