Professional Abstract
Objective
To compare the effect of two peer coaching interventions with usual care on adherence to prescribed home oxygen therapy in patients with chronic obstructive pulmonary disease (COPD)
Study Design
Design Elements |
Description |
Design |
Randomized controlled trial |
Population |
444 patients with COPD |
Interventions/
Comparators |
- Proactive phone-based peer coaching
- Reactive phone-based peer coaching
- Usual care
|
Outcomes |
Primary: use of oxygen therapy for at least 17.7 hours per day
Secondary: patient-reported measures of physical, emotional, and social health; acute care use
|
Timeframe |
60-day follow-up for primary outcome |
The study included 444 English-speaking adult patients with COPD. Patients had prescriptions for home oxygen therapy for 24 hours per day, 7 days per week. Researchers randomly assigned patients to one of three treatment groups:
- The usual-care group received educational materials about the safe use of home oxygen therapy, types of home oxygen equipment and how to use it, COPD flare-ups, and the COPD Foundation peer-coach phone line.
- The reactive-care group received the educational materials plus information about indications for and benefits of oxygen therapy, selecting an oxygen supplier, caring for patients with COPD at home, using a pulse oximeter, and recognizing and treating COPD flare-ups. The research team encouraged participants to contact the COPD Foundation peer-coach phone line with questions.
- The proactive-care group received the educational materials, plus a telephone introduction to the COPD Foundation peer coaches. They then received five peer-coach-initiated telephone sessions about home oxygen use over a 60-day period.
Peer coaches were patients, or caregivers of patients, with COPD and a prescription for home oxygen. Coaches received 45 hours of training on oxygen use and coaching.
The research team conducted assessments about oxygen use via phone at enrollment and again after approximately 60 days. The team compared oxygen adherence, defined as use of oxygen for at least 17.7 hours per day, in the proactive-care and reactive-care groups with the usual-care group. The team used Patient-Reported Outcomes Measurement Information System (PROMIS®) questionnaires to assess patients’ physical, social, and emotional health and collected data on patient-reported hospitalizations and emergency department visits.
Results
Adherence to oxygen therapy. Compared with usual care, proactive and reactive peer coaching did not significantly change adherence to oxygen therapy. Compared with reactive coaching, proactive peer coaching significantly reduced adherence to oxygen therapy (p<0.01).
Physical, emotional, and social health. Compared with usual care, proactive peer coaching significantly improved depressive symptoms (p<0.01) and sleep disturbance (p=0.04). Compared with reactive coaching, proactive coaching improved depressive symptoms (p<0.01). No differences emerged in patient-reported measures of physical function, anxiety, ability to participate in social roles, and satisfaction with social roles among the three groups.
Acute care utilization. No significant differences emerged among the study groups at 60 days in patient-reported all-cause hospitalizations or emergency department visits.
Limitations
The study lacked oxygen adherence data for 27% of study participants. Patients with missing data were less likely to have completed any education beyond high school and more likely to have been hospitalized during the 30 days prior to study enrollment. Although the researchers used statistical analysis to account for missing data and found the same results, the missing data may limit the ability to make inferences about the study population.
For adherence analyses, the team relied on patient-reported oxygen use data. Although researchers validated patient-reported data using two strategies, the reported oxygen use data may over- or underestimate adherence. Because the partnering medical supply company withdrew from the study, researchers could not collect data about changes in oxygen prescriptions. Without these data, researchers were unable to determine whether the reduced adherence in the proactive group resulted from underuse of oxygen therapy or whether coaching helped patients to update their oxygen prescriptions with their healthcare providers.
Conclusions and Relevance
Compared with usual care, proactive and reactive phone-based peer coaching did not significantly increase oxygen use by COPD patients. Proactive peer coaching significantly reduced oxygen use compared with reactive peer coaching; the reasons for this result are unclear. Compared with usual care, proactive peer coaching significantly improved depressive symptoms and sleep, suggesting that coaching may enhance some outcomes for patients with COPD.
Future Research Needs
Future research could explore why proactive peer coaching reduced home oxygen use and its role in reducing depressive symptoms and improving sleep.