Self-Management Abilities, Coursework Example

Introduction

This systematic review offers an examination of Chronic Care Models associated with Chronic Obstructive Pulmonary Disease (COPD) as it is represented by a number of studies that address different areas related to this model. This systematic review is necessary because it evaluates and summarizes a number of studies that incorporate areas such as disease management and methods of care and treatment for COPD patients. The systematic review aims to clarify some of the gaps in the literature that exist regarding disease management for this population. This review will examine ten articles that were published between 2009 and 2014 and were written by experts in countries such as the United States, The Netherlands, Denmark, and Australia, among others, primarily focused on the impact of the Chronic Care Model on COPD patients.

Methods

The studies that are included in the systematic review emphasize a number of different areas and criteria associated with COPD and the Chronic Care Model. None of the studies were conducted by nurse researchers in pursuit of the study results. The study methods are summarized as follows:

Articles: The articles specifically emphasized areas such as disease management for COPD, self-management for COPD, quality of life in COPD, active implementation of a disease management framework, and hospital-based interventions, among others. 89 percent of the studies were directly related to COPD in some form. The articles were derived from several respiratory journals, as well as journals generally related to public health and biomedical research.

Randomized controlled trials: Nine out of the ten studies used this type of study method and evaluated COPD patients under specific conditions related to quality of life, disease management, functional performance, self-management, readmission, healthcare utilization, patient evaluation, and individualized care plans, among others. In this context, the studies represented a means of understanding how different factors influence the quality of life and general management of COPD within this patient population. These randomized controlled trials represent a means of identifying patterns that impact patient quality of life within this population group and how different resources are utilized in favor of evaluating patients’ overall level of disease management and the ability to cope with specific symptoms and exacerbations.

Cross Sectional Study: One study by Cramm & Nieboer (2012) employed a cross sectional method in order to evaluate COPD patients from a number of primary care practices throughout The Netherlands and compared them to patients with Cardiovascular Disease (CVD).

Mean Age/Gender: For these studies, the mean age of participants ranged from 45 years of age to 70 years of age. In addition, six of the studies include equal numbers of male and female participants, while two studies included a higher number of males and one study included a higher number of females. For the studies with equal numbers of males and females, the mean age was 45years of age to 67 years of age, while the studies with more males had a mean age of 65-70 years of age, and the mean age of the primarily female study was 63.5 years of age.

Race/Education Level: For the majority of the ten studies, race was not relevant, with only two studies (Fan, 2012; Koff, 2009) that specifically identified race as part of the demographics. For all of the studies that were examined, level of education was not a relevant criteria for consideration.

Sample size: Each of the studies had its own specific research problem for consideration; therefore, sample sizes ranged from the smallest at 40 participants to the largest at 2,735 participants. With the smaller study, quality of life measures and integrated care were examined on a smaller scale (Koff, 2009), while the largest study comprised of 2,735 participants examined active disease management with a significant group of people that were evaluated (Smidth, 2013).

Intention –to-treat principle: In five of the studies that were examined, the intention-to-treat principle was used, while the remaining studies did not employ this principle as part of the study analysis.

Blinding: Five of the studies employed blinding, while the remaining studies did not use this principle.

Instruments used: The instruments used for the studies varied significantly, but there were also some duplicates, such as the SGRQ in four of the studies, along with the PACIC in two studies.

Biases and limitations: Some of the studies had a number of biases and/or limitations, based upon a number of indicators. Some of the most common limitations included the following: 1)a small number of patients for inclusion in some of the studies; 2)a study with an all-male participation rate; 3)lack of a control group; 4)limited external validity due to the use of one organization to generate the study population; 5)limited generalizability; and 6)no formal cost analyses. Each of these factors limits the effectiveness of the study to some degree and also demonstrates a lack of effectiveness in addressing the comprehensive nature of the Chronic Care Model for a given patient population.

Key Concepts: Key concepts introduced include disease management, COPD, self-management, individualized care plans, mortality, and healthcare utilization, among others.

Results

The study results indicate a number of important indicators of success in using the Chronic Care Model, such as the following: 1) This model may be used to improve quality of life with the appropriate level of cost analysis; 2) A potential reduction of hospitalizations may have a significant impact on cost savings for organizations; 3) An emphasis on patient education must be addressed in order to provide individuals with the ability to administer self-management techniques to improve quality of life; 4) The utilization of a case manager in some settings may be beneficial in alleviating some of the exacerbations associated with COPD; 5) Physical activity at a controlled level may contribute to higher quality care; 6) Self-management activities require ongoing evaluation in order to determine if they are sufficiently successful for the needs of this patient population; 7) A variety of interventions must be explored in order to determine the overall efficacy of the Chronic Care Model; and 8) COPD education may have a lasting impact on the number of readmissions and other issues that impact this population. In essence, the study results provide further evidence that there are a number of benefits to the Chronic Care Model that will be addressed in the following section.

Discussion

Based upon the study results, the general belief is that the Chronic Care Model provides numerous benefits to the COPD patient population and supports an effective understanding of the elements that impact this group and its symptoms. Based upon the studies that were evaluated, it is evident that the randomized controlled trials were most effective in addressing some of the needs of this population.

The study limitations were evident in that some of the participant populations were too small, only a single location was used in some cases, and other factors such as the lack of a control group for comparison purposes. Therefore, it is important to identify the specific factors under which patients will likely respond to the Chronic Care Model by minimizing bias and study criteria in order to have a significant impact on patient outcomes. It is recommended that researchers must identify the importance of recognizing the Chronic Care Model for its general value and significance to nursing practice and to cognizant of its benefits for the patient population who faces these risks on a regular basis.

References

Cramm, J. M., & Nieboer, A. P. (2012). Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Patient education and counseling, 87(3), 411-415.

Gaziano, J. M., Lew, R., Bourbeau, J., Adams, S. G., Leatherman, S., Thwin, S. S., … & Niewoehner, D. E. A Comprehensive Care Management Program to Prevent Chronic Obstructive Pulmonary Disease Hospitalizations. Annals of Internal Medicine, 156, 673-683.

Koff, P. B., Jones, R. H., Cashman, J. M., Voelkel, N. F., & Vandivier, R. W. (2009). Proactive integrated care improves quality of life in patients with COPD. European Respiratory Journal, 33(5), 1031-1038.

Smidth, M., Olesen, F., Fenger-Gron, M., & Vedsted, P. (2013). Patient-experienced effect of an active implementation of a disease management programme for COPD – a randomized trial. BMC Family Practice, retrieved from http://www.biomedcentral.com/1471-2296/14/147