Predictors of patient adherence to COPD self-management exacerbation action plans

Jade Jasmijn Schrijver (Corresponding Author), T.W. Effing, Marjolein G.J. Brusse-Keizer, Job van der Palen, Paul D.L.P.M. van der Valk, Anke Lenferink

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective
Identifying patient characteristics predicting categories of patient adherence to Chronic Obstructive Pulmonary Disease (COPD) exacerbation action plans.

Methods
Data were obtained from self-treatment intervention groups of two COPD self-management trials. Patients with ≥1 exacerbation and/or ≥1 self-initiated prednisolone course during one-year follow-up were included. Optimal treatment was defined as ‘self-initiating prednisolone treatment ≤2 days from the onset of a COPD exacerbation’. Predictors of adherence categories were identified by multinomial logistic regression analysis using patient characteristics.

Results
145 COPD patients were included and allocated to four adherence categories: ‘optimal treatment’ (26.2 %), ‘sub optimal treatment’ (11.7 %), ‘significant delay or no treatment’ (31.7 %), or ‘treatment outside the actual exacerbation period’ (30.3 %). One unit increase in baseline dyspnoea score (mMRC scale 0–4) increased the risk of ‘significant delay or no treatment’ (OR 1.64 (95 % CI 1.07−2.50)). Cardiac comorbidity showed a borderline significant increased risk of ‘treatment outside the actual exacerbation period’ (OR 2.40 (95 % CI 0.98−5.85)).

Conclusion
More severe dyspnoea and cardiac comorbidity may lower adherence to COPD exacerbation action plans.

Practice implications
Tailored self-management support with more focus on dyspnoea and cardiac disease symptoms may help patients to better act upon increased exacerbation symptoms and improve adherence to COPD exacerbation action plans.
Original languageEnglish
Number of pages8
JournalPatient education and counseling
Early online date18 Jun 2020
DOIs
Publication statusE-pub ahead of print/First online - 18 Jun 2020

Keywords

  • Chronic Obstructive Pulmonary Disease
  • Disease management
  • Self-treatment
  • Patient adherence
  • Randomised controlled trial

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