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What was the research about?

Chronic obstructive pulmonary disease (COPD) affects 24 million adults in the United States. COPD may make it hard to breathe. Patients with severe COPD may have lower levels of oxygen in the blood. Doctors often suggest that these patients use oxygen all the time when at home. But not all patients use oxygen as their doctors recommend.

Trained peer health coaches may help patients with COPD use oxygen as recommended by their doctors. Peer health coaches are people with COPD or caregivers of people with COPD. They understand home oxygen use and can give others advice about it. In this study, the research team compared patients with COPD who received phone calls from peer health coaches, patients with COPD who called peer health coaches only if needed, and patients with COPD who didn’t talk to peer health coaches. The team looked at how many hours per day patients used oxygen at home. They also looked at patients’ health and use of health care.

What were the results?

Use of oxygen. Calls from peer health coaches didn’t increase oxygen use. Patients who received five calls from peer health coaches used oxygen for fewer hours each day than patients who didn’t receive calls.

Patient health. Patients who received calls from peer health coaches had fewer symptoms of depression and sleep problems than patients who didn’t receive calls from peer health coaches. But calls from peer health coaches didn’t help patients feel less tired or anxious. The calls also didn’t improve patients’ abilities to take part in social or physical activities.

Use of health care. Calls from peer health coaches didn’t decrease the number of times patients visited the emergency room.

Who was in the study?

This study included 444 adults with COPD. Patients spoke English and had oxygen prescriptions for use at home 24 hours per day, 7 days per week.

What did the research team do?

The research team assigned patients to one of three groups by chance. Two groups didn’t receive phone calls from health coaches. In the first group, patients received written information about home oxygen use and the phone number of a peer health coach. In the second group, patients received all of this information and encouragement to contact peer health coaches for help. Patients in the third group received the written information as well as five phone calls from peer health coaches over a 60-day period to discuss any problems they had with home oxygen use. Before the study, peer health coaches received training about talking to patients about COPD and oxygen use.

The research team collected information from patients at the start of the study and again after 60 days. The team asked the patients about their oxygen use and their health. Patients reported on their depression, anxiety, sleep, tiredness, social activities, and physical activities. The team also asked patients about their emergency room visits. The team compared the results from the three groups.

What were the limits of the study?

The research team couldn’t collect completed records about oxygen use from 27 percent of patients at the end of the study. Results may have been different if the team had been able to collect information from all patients in the study. Also, patients reported the amount of oxygen they used at home. Although the research team tried to confirm the oxygen use numbers for some patients, these numbers may not be exact for all patients.

The research team couldn’t confirm the patients’ oxygen prescription from the company supplying the oxygen to patients. Patients who used less oxygen may have asked their doctors to reassess their need for home oxygen.

Future research could look at why phone calls from peer health coaches resulted in lower oxygen use in this study.

How can people use the results?

The study found that calls from peer health coaches didn’t help patients with COPD use oxygen at home as recommended. Doctors could consider using calls from peer health coaches to help patients with COPD who have feelings of depression and sleep problems.

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

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.