Pelan tindakan dengan pendidikan pesakit yang terhad hanya untuk serangan penyakit kronik paru‐paru obstruktif
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by exacerbations, usually infective in origin, which affect symptoms and quality of life. Action plans may help individuals recognise a deterioration in their symptoms and initiate changes to treatment early, thereby reducing the impact of the exacerbation.
Objectives
To assess the efficacy of action plans in the management of COPD.
Search methods
We searched the Cochrane Airways Group Specialised Register (7 July 2009), CENTRAL, MEDLINE , CINAHL and ongoing trials registers (last searched July 2009).
Selection criteria
Randomised controlled trials of an individual action plan with minimal or no self management education, compared to control in patients with COPD were included. Studies in asthma and in multi‐faceted interventions in which an action plan was combined with other elements such as education programme, exercise programme or outreach visits were excluded.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. We contacted investigators for additional information when necessary.
Main results
Five studies enrolling 574 participants with moderate or severe COPD, with follow‐up from six to twelve months, were included. There was no evidence that action plans reduced health care utilisation; assessed by hospital admission (mean difference (MD) 0.23; 95% CI ‐0.03 to 0.49), emergency department visits (MD 0.37; 95% CI ‐0.50 to 1.24) or GP visits (MD 0.53; ‐0.45, 1.50). Use of action plans was associated with increased initiation of treatment for acute exacerbations. Oral corticosteroid use was increased over 12 months (MD 0.74; 95% CI 0.14 to 1.35) with a significant increase in odds of being treated with antibiotics over 12 months (odds ratio 1.65; 95% CI 1.01 to 2.69). Self management knowledge and intention to initiate appropriate actions were improved in one study; recognition of a severe exacerbation (MD 2.50; 95% CI 1.04 to 3.96) and self initiating action in a severe exacerbation (MD 1.50; 95% CI 0.62 to 2.38). Health‐related quality of life data were limited.
Authors' conclusions
There is evidence that action plans with limited COPD education aid recognition of, and response to, an exacerbation with initiation of antibiotics and corticosteroids. Only one study measured patients' self health appropriate behaviour (decision making and taking action). There is no evidence of reduced healthcare resources utilisation or improved health‐related quality of life.The practice of giving patients an action plan and limited self‐management education for the management of COPD exacerbations, without a multi‐faceted self‐management program or ongoing case management cannot be recommended as the standard of care in COPD.
PICO
Plain language summary
Pelan tindakan untuk penyakit kronik paru‐paru obstruktif
Penyakit kronik paru‐paru obstruktif (COPD) adalah penyakit progresif yang bercirikan serangan, biasanya berasal dari jangkitan, yang boleh mempengaruhi simptom dan kualiti hidup. Pelan tindakan direka untuk membantu seseorang individu mengenali kemerosotan simptom mereka dan memulakan perubahan awal rawatan dan mengurangkan impak serangan. Ulasan ini mendapati bahawa penggunaan pelan tindakan menghasilkan peningkatan keupayaan untuk mengenal dan bertindak sewajarnya terhadap serangan oleh individu. Tidak ada bukti bahawa perubahan tingkah laku ini mengurangkan penggunaan penjagaan kesihatan atau meningkatkan kualiti kehidupan.
