Clinical trial of community nurse mentoring to improve self-management in patients with chronic obstructive pulmonary disease.

Abstract

Chronic obstructive pulmonary disease (COPD) impacts on quality of life and is characterized by exacerbations, which increase health care utilization. Developing self-management behaviors of people with COPD is an attractive strategy to reduce exacerbations. We investigated the effect of a program to increase self-management behaviors delivered by community health nurses, compared with usual care, on health-related quality of life and health care utilization in people with COPD following hospitalization. Participants were recruited during an admission to hospital and allocated according to domicile. The mentor role was to develop self-management strategies collaboratively over the 12-month study duration. Outcomes included quality of life and health care utilization. Linear mixed models analyses found a significant benefit in the physical functioning and general health components of the short-form SF-36 questionnaire for the mentored arm, with the average difference between interventions being 5.60 and 4.14, respectively, over 12 months. Survival analysis using a combined endpoint of time to next acute exacerbation requiring rehospitalization or death found a significant benefit favoring the mentored group (P = 0.037). A mentoring program designed to improve self-management behaviors in people with COPD following hospitalization increased some quality of life domains and improved important clinical outcomes.