1. Activating Primary Care COPD Patients with Multi-morbidity (APCOM) Pilot Project
Sameera Ansari1, Dr Hassan Hosseinzadeh1,
Dr Sarah Dennis2,1 and Prof Nicholas Zwar1
1 School of Public Health and Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
2 Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia

2. COPD in the context of Multi-morbidity
Image source: Barnes and Celli, 2009

3. Aims To improve patients’ self-efficacy in terms of their COPD
To enhance patients’ confidence and skills for prioritising and managing their multiple chronic conditions

4. Selection Criteria General practices across metropolitan Sydney
Employ 1 or more practice nurse
Electronic database of records
Patients
Aged between 40 and 84 years
Recorded spirometry diagnosis of COPD
Having at least one co-morbidity
History of smoking
Cognitive impairment
Poor understanding of English

5. Study Protocol

6. Intervention
Practice nurse-delivered self-management program based on the Health Belief Model
COPD knowledge
Managing exacerbations
Referral to pulmonary rehabilitation and other HCPs as necessary
Understanding inhaler device technique, importance of pneumonia and flu vaccinations
Smoking cessation and maintenance of abstinence
Prioritising and balancing their multi-morbidity
Medication management and overall wellbeing

7. Practice Recruitment 65 invited 13 consented 20 did not respond
(20%)
1 withdrew
20 did not respond
32 declined

8. Patient Recruitment and Intervention Uptake
226 invited
50 completed baseline data (22.12%)
41 attended
1 session
(82%)
38 attended
2 sessions
(76%)
35 attended
all 3 sessions (70%)
9 did not attend
any sessions
3 changed
their mind
4 were too overwhelmed
by their co-morbidities
1 was ineligible
1 was bereaved

9. Baseline Demographics (N=50)
25 male and 25 female patients
48 – 84 years (M: 69.22)
1 to 18 co-morbidities
3 to 18 medications (excluding vitamins), 0 to 4 inhalers
Smoking status:
12 current smokers
31 ex-smokers
7 never smoked

10. Outcome Measures
i) Patient Activation Measure (PAM 13) ii) COPD Knowledge Questionnaire (COPD-Q) iii) COPD Assessment Test (CAT) iv) Multimorbidity Illness Perceptions Scale (MULTIPleS) v) COPD-specific version of MULTIPleS vi) Morisky Medication Adherence Scale (MMAS-8) vii) Inhaler device technique

11. Post-test Outcomes (N = 16)
Outcome Measure
Baseline
At 6 months’ follow-up
PAM 13
57.29
64.04
COPD-Q
7.31
9.5
CAT
19.13
17.44
MULTIPleS
21.94
26.88
COPD-MULTIPleS
12.38
11.81
MMAS-8
1.25
0.62
Proper inhaler device technique
(14 patients) 12

12. Qualitative process evaluation
I can see that I helped them, they (patients) feel much better now. For some, they changed a lot, even with the views of life and how they cope up with everything, they overcame their depression, I am really happy - PN1 It (the program) gave me more tools to teach patients about their disease process, looking at not just COPD, but their other chronic illnesses and how they link together…have them put on their action plans so that they know what to do when they get sick and prevent them from going to hospital, which is what we all want to happen - PN4 After learning the right (inhaler) techniques, they got more benefits of medication…they were taking 2 or 3 puffers before, now even 1 puffer is completely enough and they do not get shortness of breath during physical activity…it means it (the education) is working - PN5

13. Implications of findings so far
Promising impact and positive uptake of our
pilot self-management program
Improved COPD self-efficacy
Enhanced patient perception of multi-morbidity
Expanded role of practice nurse in chronic disease management
Basis for upscaling the intervention to a RCT

14. The Activating Primary Care COPD Patients with Multi-morbidity (APCOM) Pilot Project is funded by GlaxoSmithKline Australia and recognised by the Australian National Health and Medical Research