Chronic diseases account for 70% of health care expenditures, and pulmonary diseases are the most expensive of the lot. Chronic obstructive pulmonary disease (COPD) leads in hospital costs, physician services, and prescription drugs.

COPD patients suffer from dyspnea, cough, sputum production, and airflow obstruction. Coupled with a complex treatment regimen, this leads to a progressive decline in quality of life, and functional capacity.
COPD is marked by frequent exacerbation episodes that often lead to hospitalization. Despite supportive inpatient care, post-discharge patients show lower functionality, and higher symptomatic burden. The current standard of care is insufficient.

Shared decision-making is a process in which health care providers and patients make joint decisions about patient care. This engages patients in an active role, empowering them as agents of their own health. This is especially valuable in chronic, complex diseases such as COPD.

Patient Education and Counseling has published a study analyzing the effectiveness of an inpatient COPD shared-decision making and patient engagement (SDM-PE) program. The control group received a standard treatment of systemic steroids, antibiotics, inhaled bronchodilators, and oxygen therapy. In addition to the standard treatment, the intervention group received an individualized SDM-PE program. Each program was tailored to the patient, who collaborated with the health care team to identify goals and strategies based on his or her own priorities.

​​​All patients were assessed at admission, discharge, and at a 3-month followup. The researchers measured variables such as symptoms, physical activity, pain, perceived health status, COPD knowledge, and adherence.
At discharge, both groups had improved in all variables, with the exception of a decrease in physical activity while inpatient. The SDM-PE group had superior improvements in pain, perceived health status, and COPD knowledge. General functionality improved in both groups, and there was no significant difference between groups.

After 3 months, the control group had worsened in all variables, while the SDM-PE group maintained or improved all measures compared to discharge values. All values were superior in the SDM-PE group, with significant between-group differences in physical measures including dyspnea, pain, functionality, and physical activity.

Moreover, SDM-PE patients had significant between-group differences in COPD knowledge, adherence, and perceived health status. These non-physical measures may be more indicative of how the intervention affected holistic health, motivation, and lifestyle.

Due to the chronic, complex nature of COPD, burdened patients may lose motivation, leading to declines in overall health and adherence. SDM-PE programs give patients an active role in tailoring their own treatments, leading to sustainable improvements in physical functionality, adherence, and holistic health. Both inpatient and outpatient practitioners should integrate aspects of shared decision-making and patient engagement.
 
M. May Zhang is a 2022 PharmD Candidate at the University of Connecticut in Storrs.


REFERENCE

Granados-Santiago M, Valenza MC, López-López L, Prados-Román E, Rodríguez-Torres J, Cabrera-Martos I. Shared decision-making and patient engagement program during acute exacerbation of COPD hospitalization: A randomized control trial. Patient Education and Counseling. December 2019. doi:10.1016/j.pec.2019.12.004.