Avoiding missed opportunities to provide guideline recommended care through hospital‐based self‐management education is becoming increasingly common. To avoid preventable re‐hospitalizations it is important to know if and when post‐hospital discharge educational reinforcement is needed. However, the durability of hospital‐based education is unknown. The objective of this two‐center randomized clinical trial was to test the short‐term effectiveness and longer‐term retention of a guideline‐based, patient‐centered approach, called teach‐to‐goal (TTG) compared to a brief intervention (BI) of simple verbal instructions to teach inhaler technique to inpatients with asthma or COPD.
Patients were randomized to TTG or BI, stratified by level of health literacy (high/low/unknown [due to insufficient vision]). Use of metered‐dose inhaler (MDI) and Diskus® devices was assessed using step‐by‐step checklists. Misuse was defined as <75% of steps correct. TTG participants received cycles of inhaler demonstration followed by re‐assessment of technique (“teach‐back”). BI participants received verbal instructions. Participants returned at 30‐days and 3 months post‐hospital discharge. Significance was tested using Chi square and Fishers exact tests.
September 2011 — October 2012, 120 participants were enrolled from two urban hospitals and were randomized to either the TTG (n=62) or BI (n=58) interventions. The majority were female (73%) and African‐American (90%), with a mean age of 47 years. Two‐thirds (66%) had been hospitalized at least once in the last year and nearly half (49%) had a near‐fatal event (ICU admission and/or intubation) in their lifetime. Fifteen percent had insufficient vision, 19% had low health literacy. Eighty‐nine percent of participants returned at 30‐days and 86% returned at 3 months. There were no baseline differences between groups (TTG vs. BI) in the baseline prevalence of misuse for either MDI or Diskus. Immediately after education, misuse was less common in TTG vs. BI for MDI (11 vs. 60%, p<0.001) and Diskus devices (5 vs. 61%, p=0.001). At 30‐days there were no significant differences in misuse for either MDI (53 vs. 70%, p=0.09) or Diskus (53 vs. 59%, p=0.73). Despite the lack of significant 30‐day findings, MDI misuse was significantly less likely at 3 months in the TTG vs. BI group (48 vs. 76%, p=0.003). A similar result at 3 months for the Diskus device was not seen (p=0.2). Stratifying the results by level of health literacy did not produce any clear patterns.
We demonstrate that although patient‐centered TTG education can improve self‐management skills among inpatients with asthma or COPD, the effects of hospital‐based education wane over time. Post‐discharge educational reinforcement is necessary for long‐term mastery. Further, data are needed about the effectiveness of hospital‐based education on subsequent clinical outcomes in the short‐term and long‐term after hospital discharge.
|Proportion of Misuse|
To cite this abstract:Press V, Arora V, Constantine K, Naureckas E, White S, Meltzer D, Krishnan J. Effectiveness and Durability of a Patient‐Centered Hospital‐Based Approach to Provide Instruction on Inhaler Technique for Patients with Asthma or Copd: A Randomized Comparative Effectiveness Tria. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 24. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/effectiveness-and-durability-of-a-patientcentered-hospitalbased-approach-to-provide-instruction-on-inhaler-technique-for-patients-with-asthma-or-copd-a-randomized-comparative-effect/. Accessed April 21, 2019.