title: Acceptance of home support and integrated care among advanced COPD patients who live outside large medical centers.
abstract: Poor self-management constitutes a risk factor for COPD deterioration. Patients from rural areas located at a considerable distance from large medical centers frequently need home-support in advanced stages of the disease. Integrated care has been proposed as a comprehensive model for appropriate treatment, coordination and holistic support. The aim of the study was to assess whether home visits provided by trained assistants are needed and accepted by advanced COPD patients living in rural areas a to evaluate whether an individual short educational program can actually improve such patients' knowledge of COPD and inhaler use.
  
  
  
  Thirty patients with severe or very severe but stable COPD participated in one-month home-assistance interventions twice a week.
  
  
  
  The total value ≥70 of SGRQ (St George's Respiratory Questionnaire) was recorded in 18 (60%) patients. At the beginning of the study, the patients' knowledge of COPD and inhalation techniques was highly unsatisfactory. Significant improvement in all items (p=0.00) was obtained after the intervention. The risk for poor self-management was high. All patients had at least one 'factor' that indicated the need for home-support. A total of 240 visits (100%) were completed. Patients expressed high acceptance for home-based support delivered by medical assistants twice a week for one month. No patients opposed this kind of care and most of them expressed interest in receiving it in the future.
  
  
  
  The results suggest a compelling need for home care and demonstrate full acceptance of this kind of support on the part of advanced COPD patients.
authors.affiliation: Department of Allergology, Medical University of Gdańsk, 80-211, Poland. Electronic address: damik@gumed.edu.pl.
authors.forename: Iwona
authors.initials: I
authors.lastname: Damps-Konstańska
authors.affiliation: Specialist Hospital, Chojnice 89-600, Poland.
authors.forename: Lidia
authors.initials: L
authors.lastname: Werachowska
authors.affiliation: Department of Pedagogy, Nicolaus Copernicus University in Torun 87-100, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Krakowiak
authors.affiliation: Specialist Hospital, Chojnice 89-600, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Kaczmarek
authors.affiliation: Department of Pneumonology, Medical University of Gdańsk, 80-211, Poland.
authors.forename: Bogumiła
authors.initials: B
authors.lastname: Cynowska
authors.affiliation: Department of Respiratory Medicine, Institute of Tuberculosis and Lung Disease, Warszawa 01-138, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Górecka
authors.affiliation: Department of Palliative Care, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-067, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Krajnik
authors.affiliation: Department of Pneumonology, Medical University of Silesia School of Medicine with Division of Dentistry, Katowice 40-055, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Kozielski
authors.affiliation: Department of Allergology, Medical University of Gdańsk, 80-211, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Jassem
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011044:Poland; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing*
keywords: Advanced COPD; Coordination; Home assistance; Integrated care