Evaluation of Patient Care Outcomes by a Multidisciplinary Team at a Chronic Obstructive Pulmonary Disease Clinic

Abstract

Chronic obstructive pulmonary disease (COPD) is a significant health concern and a leading cause of death in Thailand and worldwide. Chronic airway inflammation causes airflow obstruction and damage to lung tissues and alveoli, resulting in progressive, not fully reversible airflow limitation. Its condition leads to the decline of lung function and other systems, thereby reducing quality of life. The management of patients with COPD focuses on reducing symptoms and the future risk of exacerbations. Patients with COPD require comprehensive care; therefore,collaboration among a multidisciplinary team is needed to enhance patient outcomes and increase
patient satisfaction with care. Literature reviews have found that multidisciplinary team care of patients with COPD could improve clinical outcomes. However, there have been limited studies on the outcomes of changes in self-care behaviors among people with COPD resulting from a multidisciplinary team. Previous studies revealed that good self-care behaviors could positively affect patient outcomes. Therefore, evaluating the outcomes of multidisciplinary care for patients with COPD should encompass various aspects to clearly reflect the quality of care. According to Donabedian’s framework, the assessment of healthcare quality consists of three components:structure, process, and outcome. Outcomes refer to changes in the healthcare of patients that are influenced by the process and structure of healthcare providers.

This descriptive study aimed to examine the outcomes of patients with COPD under the care of a multidisciplinary team, which included self-care behaviors, dyspnea, physical activity,quality of life, and satisfaction with care. Purposive sampling was employed to recruit 87 participants at a tertiary hospital in Bangkok, Thailand from March to June 2022. Participants were patients diagnosed with COPD who met the following inclusion criteria: 1) aged 40 years and above, 2) received multidisciplinary care at COPD clinic for at least one year, 3) regularly attending follow-up treatment for at least 80% of the time, 4) were able to understand and communicate in Thai, 5) were willing to give informed consent, 6) for participants aged 60 years and above, having normal cognitive function, assessed by the Six-item Cognitive Impairment Test: 6CIT with a score less than 8 out of 28. Participants were asked to complete six questionnaires:the Patient Information and Health Data Questionnaire; the Dyspnea Assessment Scale; the Veterans Specific Activity Questionnaire; the Self-Care Behaviors for COPD Questionnaire; the Quality of Life Questionnaire for COPD; and the Satisfaction with Care Questionnaire. Data were analyzed using descriptive statistics.

The results showed that the participants were mostly men with a mean age of 64.49 years (SD = 10.72). They were diagnosed with COPD for 1-15 years (mean = 4.37 years, SD= 2.89), being in the COPD group A (52.9%), and most of them (55.2%) had moderate airflow limitation (GOLD stage 2). Most participants used combination inhalers for treatment; 49.43%of the participants experienced one or more exacerbations per year. However, 14.94% of all participants were hospitalized due to exacerbations of their conditions. The participants exhibited relatively high self-care behaviors with a mean score of 104.97 (SD = 9.14) out of a total score of 124, with the highest average score in the domain of appropriate medication use. Most participants reported the severity of dyspnea symptoms as grade 0 (37.93%), followed by grade 1 of dyspnea symptoms (33.33%). Almost all participants (93.10%) engaged in physical activity with a metabolic equivalent (MET) level of three or above. They reported a relatively high quality of life with a mean score of 79.08 (SD = 9.10) out of a total score of 100. In addition, participants reported satisfaction with care, with a mean score of 72.79 (SD = 1.95) out of a total score of 75. The majority of participants (94.25%) expressed the highest scores in the aspect of “being treated with dignity and respect,” followed by 91.95% of the participants for “having time to discuss their concerns” and “receiving continuity of care.” The positive outcomes of the participants reflect a well-structured organization, a systematic COPD clinic, and a process of care facilitated through the collaboration of a multidisciplinary team, which contributed to the outcomes. All outcomes of patients with COPD could reflect the quality of care provided by the multidisciplinary team. A multidisciplinary team-based care system for the patient with COPD should be established to enhance the quality of care and improve overall patient outcomes.

Keywords: Chronic obstructive pulmonary disease, Multidisciplinary care, Multidisciplinary team, Patient outcomes