Journal of Pulmonary Medicine & Respiratory Research Category: Medical Type: Review Article
The Effects of Transitional Care on Quality-Of-Life in Patients with Chronic Obstructive Pulmonary Disease: Literature Review
- GAO Yingxue1, Cheng Shouzhen2*
- 1 Department Of Nursing, The First Affiliated Hospital Of Sun Yat-sen University, China
- 2 Department Of Nursing, The First Affiliated Hospital Of Sun Yat-sen University, China
*Corresponding Author:Cheng Shouzhen
Department Of Nursing, The First Affiliated Hospital Of Sun Yat-sen University, China
Received Date: Feb 04, 2017 Accepted Date: Apr 28, 2017 Published Date: May 12, 2017
This article reviews the scholarly literatures with the following keywords: transitional care, continuity of care, discharge planning, care-coordination, follow-up after discharge and COPD to identify transitional care models which have been used successfully in patients with COPD.
THE DEFINITION OF TRANSITIONAL CARE
CONTENTS OF TRANSITIONAL CARE
THE RESEARCH PROGRESS OF TRANSITIONAL CARE ON PATIENTS AFTER DISCHARGE
b. The transitional care model at abroad has developed multi-discipline coordination team which considered nurse as the core, and has achieved good social and economic benefits, which mainly include two models respectively based on community and hospital. The former refers to the family hospital and day hospital, and the latter refers to provide medical care services in family to replace the hospital process, the population pointed at patients with acute exacerbation of chronic disease but not yet fully recovered, especially chronic obstructive emphysema, chronic congestive heart failure and so on. Day hospital stems from the UK health care service system to provide self-care ability training, rehabilitation care services in the day for the elderly, or patients with pain and chronic diseases, in this system the senior specialist nurse as the leading, and physicians, physical therapists, nutritionist, and social workers, etc. are collaborated.
THE EFFECTS ON RECURRENCE AND HOSPITALIZATION, PATIENT’S SELF-EFFICIENCY, SATISFACTION AND COMPLIANCE
Related studies have reported that symptoms can be controlled and supervised through transitional care. Several studies have showed that transitional care can reduce hospital re admissions [18-20], and among which one study showed that patients enrolled in the transitional home care program had significantly lower acute hospital utilization through the reduction of emergency department attendances and hospital admissions . The clinical data of 60 patients in the hospital were retrospectively studied , patients in intervention group were given transitional care after discharge, meanwhile patients in the controlled group were given regular treatment and no longer took actions after discharge, and then compare the exacerbation rate between two groups. The rate in intervention group were significantly lower than the other, which concluded that transitional care can reduce the exacerbation rate and contribute to the improvement of the quality of life, which is worthy to be popularized clinically. A study proved that transitional care can effectively reduce the rate of outpatient visits and re-hospitalization . Research Zeng  found that through twice telephone visit, the physical activity, mood fluctuations and CSES (General Self-Efficacy Scale) scores in intervention group were significantly higher than those in control group. Liu Hong  conducted a study through telephone follow-up, family visits and provided expert outpatient for patients with COPD, the CSES score of the intervention group were higher than the control group, which also proved that the continuity of care can effectively improve the patient's satisfaction and compliance, and even reduce the recurrence rate and hospitalization rate.
THE EFFECTS ON LUNG FUNCTION
Xia Yulan  established the Department of Home Respiratory Rehabilitation Training Group, providing discharge guidance and respiratory function exercise guidance, to evaluate the pulmonary function through FEV1, FVC and FEV1/FVC to evaluate the activity tolerance and quality of life according to the 6-min walk test, the blood pressure and heart rate, blood oxygen content and Borg score, and found that transitional care can improve activity endurance, improve lung function and the quality of life. Wang Shaoling  observed one patient and conducted a follow-up by telephone visit and family visit also proved this viewpoint. Additionally, activity endurance, quality of life and self efficacy were improved after 6 weeks, and the number of re hospitalization within 1 years was significantly reduced from 6 to 2 per year, according to the study of Wang Caixia , in which 161 patients with mild to moderate COPD were given behavioral intervention, psychological intervention and health guidance. The patients with pulmonary function, respiratory problems, body mass index, 6-min walk test, daily living activity and life satisfaction index were proved effective during the process. Domestic scholars studied  that patients’ respiratory muscle endurance were significantly improved after six weeks of 6-min walk test combined with abdominal breathing training, and related pulmonary symptoms were improved too, pulmonary function index (FEV1, 6MWT, FEV1/FVC, heart rate and finger vein oxygen) were also significantly improved. Yao Wenmei  explored the effects of respiratory training on the lung function of patients with COPD, 70 patients were guided to do contraction lips breath and abdominal breath for 6 months, FEV1/FVC and other indexes were significantly improved too.
THE EFFECTS ON PSYCHOLOGICAL STATUS
Some researches provided follow-up service to promote communication between nurses and patients to improve negative emotions of patients. They set up a telephone hotline to patient’s consultation and encourage them to do emotional relaxation exercises. Apart from these, they also actively mobilize the social support, such as family, relatives or friends, to improve patient's psychological satisfaction, establish self-confidence to fight against disease . In addition, patients with COPD are mainly the family's economic pillars, they cannot continue to work due to the change of health status and thus produce anxiety and depression emotions. Therefore long-term psychological intervention and guidance is needed to assist them to adapt to chronic diseases and take positive attitude towards disease . Professor Al-Gamal  of Jordan University explored the relationship between anxiety, depression and quality of life on patients with COPD, and found that the higher the degree of anxiety and depression, the lower the quality of life on patients, the relationship between them promotes nursing workers to gradually make a shift to provide home care, concentrate on patients’ psychological status to improve the quality of life on patients with COPD. Liu Lei  studied 110 COPD patients, classified them into two groups randomly. Patients in the intervention group was followed-up by telephone, and those in the control group were treated with regular care, the research finally found that the quality of life on patients in the intervention group was significantly higher than that in the control group, and the degree of psychological anxiety was significantly lower than the other. Researcher’s  studied 102 patients with COPD, among them fifty patients were treated with health education in family, and found that the rate of rehospitalization, the number of smoking patients and self assessment tests in the health-education group were lower than those in the control group, and the level of self management and family function were significantly higher than those in the control group. It proved that health education in family can effectively improve the self-management level and family function of patients with COPD. Dyspnoea 12 scales, Hospital Anxiety and Depression Scale were used to evaluate the relationship between respiratory depression and anxiety, which showed that the level of dyspnea and anxiety/depression were positively correlated. Moreover, the study pointed out the necessity of family continuity care and the future development direction which is based on the center of family .
APPLICATION OF OMAHA SYSTEM BASED ON COPD
Omaha system not only provides nurses with an effective tool to collect, collate, record and analyze data of patients, but also guide them to carry out a comprehensive assessment, to correctly diagnose the health problems and give effectiveness assessment aimed the problem. In addition to regulate the quality of nursing documents, Omaha system is conducive to control and improve the quality of care . Therefore, Omaha system could be applied to the evaluation of transitional care on patients with COPD, which contribute to improve the quality of life and the quality of care.
Extensive use of network platform to carry out transitional care service
The establishment of patient clubs
Standardize the content and operation process of transitional care
From the current research on transitional care model, we can conclude that the application development of transitional care model on patients with COPD in China is still not perfect, and there is no definite index to evaluate the quality of life of patients. The current evaluation index is focused on the number of acute exacerbation, patient satisfaction and compliance of respiratory function exercise. With the further improvement of social health requirements, the requirements of transitional care will be increased, but transitional care in our country started up late, so we would learn advanced experience from foreign countries and considered this model as a part of clinical nursing.
From the existing researches, we concluded that the psychological status of patients and their caregivers significantly affected the prognosis of COPD. In comparison, the development of foreign transitional care is already mature, which focused more on the psychological status of patients and their caregivers, and the development direction of transitional care in our country should pay more attention to psychological care of patients and their caregivers. In addition, transitional care in our country still concentrated on the home care, and the role of nursing has not been fully played in community. In future, community care will become a trend of transitional care.
- Global Initiative for Chronic Obstructive Lung Disease (2016) Global Strategy for Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease, USA.
- Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, et al. (2006) Global burden of COPD: systematic review and meta-analysis. Eur Respir J 28: 523-532.
- Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, et al. (1997) Chronic Obstructive Pulmonary Disease Stage and Health-Related Quality of Life. Ann Intern Med 127: 1072-1079.
- Stoller JK (2002) Acute Exacerbations of Chronic Obstructive Pulmonary Disease. N Engl J Med 346: 988-994.
- Ramsey SD, Sullivan SD (2003) The burden of illness and economic evaluation for COPD. Eur Respir J Suppl 41: 29-35.
- Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, et al. (1998) Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157: 1418-1422.
- Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, et al. (1987) Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106: 196-204.
- Brian HR (2013) Risk Stratification of Patients with AECOPD. Curr Emerg Hosp Med Rep 1: 181-188.
- Li Y, Wei L, Baolan L, et al. (2015) Effect of discharge planning services on the quality of life in 110 patients with chronic obstructive pulmonary disease. Chongqing medicine 44: 3162-3165.
- Boockvar K, Vladeck BC (2004) Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc 52: 855-856.
- Hongxu Z, Hongtao Y, Ping X (2013) The Status Quo of Continuing Nursing in China. Nursing Research 27.
- Shaoling W, Jinyue H, Jiayi Z (2009) Evidence - based Practice of Continuing Nursing of Chronic Obstructive Pulmonary Disease. Chinese Journal of Nursing 44.
- Moon G (2006) The amount of care and healing required for continuous care after discharge. Chinese Nursing conference.
- Shu-hua X, Jijun Z, Jianhua Z, Peiwen Z (2007) The General Situation and Inspiration of Discharge Service of Successful University Hospital. Chinese Journal of Nursing 42.
- Guangna M, Xequin L (2005) Discussion on Continuing Nursing Service Mode of Discharged Patients 19: 1294-1295.
- Xiang H, Li Z (2000) Use of hospital care card. Shanxi Journal of nursing 14.
- Liming Y, Ying W (2012) Internal Medical Nursing, (5th edn), People’s Health Publishing House.
- Jayakody A, Bryant J, Carey M, Hobden B, Dodd N, et al. (2016) Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review. BMC Health Services Research 16.
- Lainscak M, Kadivec S, Kosnik M, Bratkovic M, Jakhel T et al. (2013) Discharge coordinator intervention prevents hospitalizations in patients with COPD: a randomized controlled trial. J Am Med Dir Assoc 14: 1-6.
- Nelson JM, Pulley AL (2015) Transitional care can reduce hospital readmissions. Am Nurs Today 10.
- Low LL, Vasanwala FF, Ng LB, Chen C, Lee KH, et al. (2015) Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study. BMC Health Serv Res 15: 100.
- Ying W (2014) On patients with chronic obstructive pulmonary disease effects of extended care. Contemporary Medicine Forum.
- Yujing D, Shaomei S, Li Y (2012) The progress of continuing care in foreign countries. Chinese Nursing Management.
- Qunli Z, Helen, Hui H, Wu J, Mingxiu C et al. (2010) Telephone follow-up for patients with chronic obstructive pulmonary disease effect of self-efficacy. Journal of Nursing Science 25.
- Hong L, Xia L, Aili Z, Dan S, Yumei L (2013) Study on the Effect of Continuing Nursing of Chronic Obstructive Pulmonary Disease. Chinese General Practice 16.
- Barreiro E, Gea J (2015) Respiratory and Limb Muscle Dysfunction in COPD. COPD 12: 413-426.
- Liping Z, Lifang P (2015) Effect of Breathing Exercise on Pulmonary Function in COPD Patients with Stable. Journal of Clinical Medicine in Practice.
- Xiaomin F, Hongmei Z, Fei J, Chunling D, Qiong G, et al. (2010) Rehabilitation Effect of Respiratory Training on Stable Patients with Chronic Obstructive Pulmonary Disease. Nursing Journal of Chinese People’s Liberation Army 27.
- Liao LY, Chen KM, Chung WS, Chien JY (2015) Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis 10: 1703-1709.
- Yulan X, Xiaoli L, Village LR, Yunlan T, Mingyu S (2014) Effects of Family Continuity nursing on Pulmonary Function, Exercise Endurance and Quality of Life in COPD Patients. International Journal of Nursing 11.
- Shaoling W, Shiyan F, Kayee S, Kam-yuet W (2011) Continuous care of patients with chronic obstructive pulmonary disease. Chinese Journal of Nursing 46.
- Caixia W, Xianqiao J, Derong P, Zhen AW, Wei S(2012) Effect of community lung rehabilitation on quality of life in patients with mild to moderate chronic obstructive pulmonary disease. Chinese Journal of Nursing 47.
- Wenjie H, Fang H, Hongyan Z, Jianzhen W (2013) Application of 6min Walking Combined Breathing Training in Rehabilitation Nursing of Patients with Chronic Obstructive Pulmonary Disease. Nursing Practice and Research.
- Wenmei Y (2012) Effect of Respiratory Training on Pulmonary Function of Chronic Obstructive Pulmonary Disease and Nursing. China practical China Practical Medicine 47..
- Leupoldt VA, Kenn K (2013) The psychology of chronic obstructive pulmonary disease. Curr Opin Psychiatry 26: 458-463.
- Jiamei L, ZhaohuiZ, Wei C, Qionghui L, Bizhen X, et al. (2012) Effect of Continuing Nursing on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Chinese Journal of Nursing 47.
- Li JM, Cheng SZ, Cai W, Zhang ZH, Liu QH, et al. (2014) Transitional care for patients with chronic obstructive pulmonary disease. International Journal of Nursing Sciences 1: 157-164.
- Al-Gamal E (2014) Quality of Life, Anxiety and Depression among Patients with Chronic Obstructive Pulmonary Disease and their Spouses. Issues Ment Health Nurs 35: 761-767.
- Lei L, Xiaoxia Y, Jie Z, Yan G, Man L (2014) Intervention Effect of Continuing Nursing on Patients with Chronic Obstructive Pulmonary Disease. Chinese Journal of Gerontology.
- Hong LH (2015) Family Health Education Evaluation continuation of care in patients with chronic obstructive pulmonary disease. Chinese journal of Prevention and control of chronic diseases 23.
- Al-Gamal E, Yorke J (2014) Perceived breathlessness and psychological distress among patients with chronic obstructive pulmonary disease and their spouses. Nurs Health Sci 16: 103-111.
- Martin KS (2005) The Omaha System: A Key to Practice, Documentation, and information Management. Elsevier Saunders, Philadelphia, USA.
- Yanyun Q, Xiaying L, Yanling C (2013) Application of Omaha System in Rehabilitation of Community COPD Elderly Patients. Jilin Medical Journal 34.
- Junqing Z (2015) Application of Case Management Nursing Model with Omaha System as a Framework in Patients with Chronic Obstructive Pulmonary Disease. Nursing Practice and Research.
- Jing-yue H, Shao-ling W, Jia-yi Z (2010) The Application of Omaha System in Community Nursing and Continuing Nursing. Chinese Journal of nursing 45.
Citation:Yingxue G, Shouzhen C (2017) The Effects of Transitional Care on Quality-Of-Life in Patients with Chronic Obstructive Pulmonary Disease: Literature Review. J Pulm Med Respir Res 3: 009.
Copyright: © 2017 GAO Yingxue, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.