Comprehensive Patient-centered Home-based care coaching for COPD self-management
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Chronic obstructive pulmonary disease (COPD) affects 10-15% of U.S. adults, costs over $37 billion annually, and causes serious symptoms, physical impairment and high hospital admission and mortality rates. Much of its burden can be reduced by following guideline recommended self-care activities, like daily use of disease controlling medications and pulmonary rehabilitation. Yet patients often struggle with the self-care needed to maintain or improve their health. The potential barriers to successful self-care are numerous, encompassing socioeconomic, psychosocial, physical, cognitive and other domains. Moreover, many of the barriers are major contributors to health inequities, as reflected in poorer access to COPD treatments and poorer outcomes among racial and ethnic minority patients. Most COPD self-management support interventions have largely followed one-size-fits-all strategies of education and training. We created the Supporting self-Management Behaviors for aging Adults (SaMBA)-COPD intervention based on the successful SaMBA program for older adults with asthma. The model is unique among chronic illness self-management programs because it involves comprehensive screening for barriers to self-management and disease control and couples it with tailored, theory-based, barrier- specific interventions. The intervention is delivered by community health workers and includes steroid and antibiotic prescribing for early intervention of COPD exacerbations and home-based pulmonary rehabilitation (HBPR). Our feasibility trial of SaMBA-COPD, conducted with a predominantly Black and Latinx population, met most of the benchmarks for success, including complete preparation of all intervention and study related materials and protocols, intervention fidelity and patient acceptability, and outcomes that suggest the intervention will improve self-management behaviors and reduce COPD symptoms. We now propose a fully powered randomized trial among inner-city adults with COPD (n=300). The Specific Aims are to test the impact of SaMBA- COPD on (1) COPD controller medication adherence and other self-management behaviors at 6 months; (2) on clinical outcomes (COPD symptoms measured with the COPD Assessment Test and 6-minute walk test distance) at 6 months, and emergency department visits and hospitalizations at 12 months; and (3) to examine mechanisms of intervention effect on medication adherence and clinical outcomes, with a focus on the role of COPD illness and medication beliefs. We will recruit adults ages 40 years and older with advanced COPD in outpatient practices in New York City. The intervention will be delivered for 6 months. Attention control patients will receive untailored COPD education. Sustainability of treatment effects will be evaluated at 12 months. The intervention is significant and innovative for its comprehensive pre-trial preparation, attention to the full range of contributors to suboptimal self-management and COPD control, the broadening of community health workers' scope of practice to include HBPR, and the project's focus on achieving equity in healthcare and health outcomes for Black and Latinx COPD patients.
