Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project.
BACKGROUND
Pulse oximetry could potentially contribute to self-monitoring. NHS Lothian's 'Light Touch' service provided COPD patients with a self-management plan based on symptoms and oximetry. The service was overseen (though not actively monitored) by respiratory-trained community teams who were contactable by a telephone helpline. We aimed to assess the feasibility, perceived utility and impact of the 'Light Touch' service.


METHODS
A before-and-after assessment of St George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS) and use of healthcare resources during the 6-month feasibility study compared to the previous corresponding 6-months. Paired semi-structured interviews with patients at baseline and 6-months, interviews with managers and a focus group of professionals explored perceptions of the service and self-management. Transcripts were coded, and analysed thematically.


RESULTS
We recruited 51 participants (mean age 69.7 years (SD 8.4); 21 (46%) male). 46 participants completed quantitative follow up (2 died, 2 were unwell, 1 refused). SGRQ: 21 (46%) participants improved by 4 or more (the minimum important difference); 12 (26%) deteriorated by 4 or more. HADS: more participants had normal scores for anxiety (65%) and depression (80%) at 6-months than at baseline (51 and 64%). More emergency therapy was prescribed during the study period compared to the previous year. Only 18 participants (39%) contacted the Light Touch Helpline during the 6-month study. Twenty patients provided a total of 36 interviews, 8 clinicians contributed to a focus group and 6 managers were interviewed. Patients considered that the oximetry readings heightened awareness of their condition and gave them confidence to make self-management decisions. Healthcare professionals valued oximetry as a tool for teaching people self-management skills, but were concerned that patients rarely contacted the teams for help or advice during the study.


CONCLUSIONS
'Light Touch' shows promise as a low-cost strategy for empowering patients' self-management skills and reducing reliance on clinical supervision.
e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK. Michele.McNab@ed.ac.uk.
Michele
M
MacNab
Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. Siew.Lee@ul.ie.
Siew Hwa
SH
Lee
e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK. Lucy.McCloughan@ed.ac.uk.
Lucy
L
McCloughan
School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK. J.Hanley@napier.ac.uk.
Janet
J
Hanley
e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK. Brian.McKinstry@ed.ac.uk.
Brian
B
McKinstry
Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK. hilary.pinnock@ed.ac.uk.
Hilary
H
Pinnock
D000368:Aged; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D015277:Hotlines; D006801:Humans; D008297:Male; D010092:Oximetry / Q000379:methods*; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires