Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project

MacNab, Michele; Lee, Siew Hwa; McCloughan, Lucy; Hanley, Janet; McKinstry, Brian; Pinnock, Hilary

Abstract

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.
Keywords: Chronic obstructive pulmonary disease (COPD), Self-management, Telemonitoring, Primary care,
Delivery of care

• Journal Article Type: Article
• Acceptance Date: Oct 9, 2015
• Online Publication Date: Oct 26, 2015
• Publication Date: Jun 26, 2017
• Deposit Date: Jun 13, 2017
• Publicly Available Date: Jun 14, 2017
• Journal: BMC Health Services Research
• Publisher: BMC
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 1
• DOI: https://doi.org/10.1186/s12913-015-1135-2
• Keywords: Chronic obstructive pulmonary disease (COPD), Self-management, telemonitoring, primary care, delivery of care
• Public URL: http://researchrepository.napier.ac.uk/Output/930826
• Contract Date: Jun 13, 2017