Treatment burden in COPD - Findings from a pragmatic, multicentre pilot randomised controlled trail (RCT) in primary care: Tailored Intervention for COPD and Comorbidities by Pharmacists & Consultant Physicians (TICC PCP)

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

5C.9

Presenter:

Karen Wood

Twitter:

@gppcglasgow

Co-authors:

Georgia Smith, Richard Lowrie, Jennifer Anderson, Jane Moir, Andrew McPherson, Dave Anderson, Elaine Rankine, Donald Noble, Lynda Attwood, Gillian Cameron, Aziz Sheikh, Nicola Greenlaw, Bethany Stanley, Frances Mair

Author institutions:

General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow; Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow; University of Edinburgh; NHS Greater Glasgow and Clyde; NHS Lothian

Problem

People living with moderate-to-severe Chronic Obstructive Pulmonary Disease (COPD) may experience high levels of treatment burden, particularly if they have comorbidities. Treatment burden refers to the ‘work’ involved in managing health conditions and the impact on patients’ wellbeing. This work can be complicated by care deficiencies. The capacity of people with COPD to cope with complex treatment regimens and self-management tasks varies according to factors such as socioeconomic status, health literacy, education, social supports and physical/mental abilities. However, there is limited evidence about the treatment burden experienced by people with COPD and co-morbidities.

Approach

Pilot randomised controlled trial (RCT) of a home-based pharmacist intervention for people with moderate-to-severe COPD and comorbidities in NHS Greater Glasgow and Clyde and NHS Lothian. 110 participants recruited from specialist respiratory consultant led clinics. Baseline questionnaire data collected in person, including Patient Experience with Treatment and Self-management (PETS) scale (60 item, 12 domain validated patient reported measure of treatment burden). Higher PETS scores indicate greater treatment burden. Participants randomly allocated to Pharmacist independent prescriber intervention for up to one year in addition to Usual Care, or Usual Care. Intervention participants received holistic care (e.g. prescribing/referral to other services/support in making lifestyle changes/management of COPD/other health conditions) from Pharmacist home visit. Qualitative telephone interviews conducted with 10 Health Care Professionals (HCPs)/study staff and sub-sample of 20 intervention patients. Semi-structured interviews explored experiences of living with and managing COPD and comorbidities. Interviews audio-recorded and transcribed verbatim. Data were analysed thematically and conceptualised through a Normalisation Process Theory lens and with reference to the Cumulative Complexity Model (CCM).

Findings

110 patients completed the baseline questionnaire, 59% were female, mean age was 67 years. Mean number diagnoses were: respiratory 2.8; non-respiratory 7.6; and mental health 1.1. PETS domains which indicated high levels of treatment burden included those relating to limitations on role/social activity, difficulties with healthcare services, medical appointments and relationships with others. Qualitative data further illustrated participants’ experiences of treatment burden and also identified factors which may lessen burden such as family support and good relationships with HCPs.

Consequences

This study provides new insights into areas of treatment burden experienced by those living with moderate-to-severe COPD and comorbidities. Collaborative home visits by independent prescriber pharmacists were valued and have the potential to positively impact treatment burden. Measures of treatment burden can provide improved understanding of self-management experiences and could be included as a key intervention target in RCTs.

Submitted by:

Karen Wood

Funding acknowledgement:

Chief Scientist Office and Chiesi