Table 1
Integrated care intervention scheme.
| Domain | Problems | Interventions |
|---|---|---|
| Environment | Residence | (1) Improve home environment and ventilation; (2) eliminate the predisposing factors at home (such as smoke, lampblack, dust, and animals) and preventions; and (3) select residential conditions with elevators if possible |
| Income | (1) Draw up an income and expenditure plan; (2) guide the patient to seek treatment and professional care for free; and (3) seek community resources, government clinics, and social supports | |
| Sanitation | (1) Teach patients the effective ways to prevent infection; (2) introduce the term of validity and storage methods of medical products to patients; (3) introduce the disposal of household medical rubbish; and (4) clean and maintain the inhalators | |
| Psychosocial domain | Social contact | (1) Encourage patients to have more social contacts and to get out and (2) control social time and frequency to prevent the aggravation of the disease |
| Spirituality | (1) Provide information about diseases and treatment and relieve the anxiety and fear of patients; (2) observe patients’ psychic reaction and behavior change and listen to patients; (3) provide psychological counseling and self-mental hygiene training; (4) relaxation training; (5) self-care ability training; (6) provide training for overcoming psychological obstacles and seeking social supports; and (7) encouragement from medical staffs | |
| Caretaking/parenting | (1) Introduce state of illnesses, psychological status, health care of the patient’s desired and care skills and (2) seek family and community resources | |
| Physiological domain | Hearing | (1) Avoid noisy activities and environment; (2) not to pick one’s ears; and (3) hearing examination regularly |
| Vision | (1) Guide the patient to take safety protection measures, such as wear glasses, and activity in the adequate lighting and (2) ophthalmologic examination regularly | |
| Oral health | (1) Remove local excitation, such as dental tophi, mouth breathing, and smoking; (2) use soft toothbrush and mouthwash after meals to protect gingiva; (3) see a dentist | |
| Cognition | (1) Emphasis on importance of COPD disease cognition and (2) health education of relevant knowledge of rehabilitation | |
| Pain | (1) The frequency, nature, place, reason, and degree of pain (pain assessment tools); (2) methods to relieve the pain, including deep breathing, imagine, distract attention; (3) physiotherapy: hot compress, physical therapy, and acupuncture; and (4) the effect and side effect of analgesic drugs | |
| Skin | (1) Inspect skin irritation and damage and (2) wound care if necessary | |
| Neuromusculoskeletal function | (1) Guide patients to turn around on bed and (2) guide right ways of body movement | |
| Respiration | (1) Evaluate respiratory morphology, volume, character, and smell of sputum; (2) teach patients methods of effective cough and relieve asthma; (3) respiratory coordination in daily activities; (4) objective, necessity, methods, and considerations of home oxygen therapy; (5) respiratory function exercises, such as abdominal respiration and pursed lip breathing; (6) lung percussion; (7) loosening up activities; and (8) home visit regularly, evaluate training effect, and revise pulmonary rehabilitation training program timely | |
| Circulation | (1) Emphasize the importance of monitoring blood gas analysis; (2) measure blood pressure in fixed time interval and position; (3) avoiding factors that induce to catch cold, cold air, overstrain, etc.; and (4) electrocardiographic examination regularly | |
| Digestion–hydration | (1) Introduce the pathogeny, clinical manifestation, and nursing of complications of digestive system; (2) reasonable diet and pharmacy under the guidance of professionals; and (3) avoiding predisposing causes such as infection and injury | |
| Bowel function | (1) Observe the color, nature, frequency, and volume of bowel; (2) analyze influencing factors of bowel movement, provide guidance on diet, exercise, and health education, and so on; (3) protect perianal skin; (4) abdominal massage; and (5) defecate daily | |
| Urinary function | (1) Guide the time and volume of drinking and (2) keep perineal region clean | |
| Communicable/infectious condition | (1) Prevention and treatment of respiratory infectious diseases and (2) pulmonary function test regularly | |
| Health-related behaviors domain | Nutrition | (1) Dieteric treatment; (2) guide low salt, low fat, protein, light diet, have more meals a day but less food at each; and (3) keep the eating environment clean and tidy |
| Sleep and rest patterns | (1) Analyze the influence factors of interfering sleep, such as psychology, physiology, and illness, discuss the methods to promote sleep with patients; (2) instruct to distract attention, relaxation exercises, and imagination; (3) avoid the influence factors, such as drinking or smoking at bedtime; and (4) introduce the efficacy and side effects of sleeping pills | |
| Physical activity | Physical fitness training, such as take a walk regularly; jogging; shadowboxing, and lifting | |
| Rehabilitative guidance | (1) The significance and methodology of home rehabilitation and (2) execute correctly comprehensive rehabilitation program at home | |
| Personal care | (1) Guide patients self-care skills in daily life and (2) self-monitoring of temperature | |
| Health service | (1) Emphasize the importance of self-care, teach patients to take care of themselves and (2) supervise and urge to coincide with treatment planning | |
| Substance use | (1) Guide patients to use medicine properly; (2) deal with the expired drugs; and (3) use inhalation and aerosols correctly |
[i] COPD, chronic obstructive pulmonary disease
Table 2
Demographic data of the subjects (n=117).
| Control group | Intervention group | |||||
|---|---|---|---|---|---|---|
| Characteristic items | n = 57 | (%) | n = 60 | (%) | χ2 | P |
| Age (years) | ||||||
| ≤40 | 8 | 12.5 | 5 | 7.81 | -0.266 | 0.790 |
| 41–59 | 14 | 21.88 | 14 | 21.88 | ||
| ≥60 | 42 | 65.63 | 45 | 70.31 | ||
| Gender | ||||||
| Male | 32 | 50.00 | 40 | 62.50 | -1.426 | 0.156 |
| Female | 32 | 50.00 | 24 | 37.50 | ||
| Education level | ||||||
| Primary school and below | 22 | 34.38 | 21 | 32.81 | 0.000 | 1.000 |
| Junior school | 16 | 25.00 | 20 | 31.25 | ||
| High school | 17 | 26.56 | 13 | 20.31 | ||
| University and above | 9 | 14.06 | 10 | 15.63 | ||
| Marital status | ||||||
| Unmarried | 2 | 3.13 | 1 | 1.56 | 0.580 | 0.563 |
| Married | 62 | 96.88 | 63 | 98.44 | ||
| Primary caregivers | ||||||
| Spouse | 13 | 20.31 | 12 | 18.75 | -0.511 | 0.610 |
| Children | 16 | 25.00 | 19 | 29.69 | ||
| Patients themselves | 35 | 54.69 | 33 | 51.56 | ||
| Duration of disease (years) | ||||||
| <1 | 8 | 12.50 | 10 | 15.63 | -1.710 | 0.090 |
| 1–5 | 28 | 43.75 | 27 | 42.19 | ||
| 6–10 | 17 | 26.56 | 15 | 23.44 | ||
| >10 | 11 | 17.19 | 12 | 18.75 | ||
| Complications | ||||||
| 0 | 31 | 48.44 | 24 | 37.50 | -0.713 | 0.477 |
| 1 | 21 | 32.81 | 29 | 45.31 | ||
| ≥2 | 12 | 18.75 | 11 | 17.19 | ||
Table 3
Comparison of quality of life between the two groups before discharge (M±SD).
| Before discharge | ||||
|---|---|---|---|---|
| Items | Control group (n=64) | Intervention group (n=64) | t | P |
| PF | 70.08±22.14 | 68.36±23.64 | 0.425 | 0.672 |
| RP | 24.61±20.65 | 26.95±25.71 | -0.569 | 0.571 |
| BP | 56.49±22.96 | 59.27±13.07 | -0.840 | 0.403 |
| GH | 46.02±14.69 | 41.45±16.64 | 1.644 | 0.103 |
| VT | 62.66±14.72 | 61.95±12.59 | 0.290 | 0.772 |
| SF | 44.53±15.08 | 48.24±13.52 | -1.465 | 0.145 |
| RE | 71.88±36.72 | 68.75±41.09 | 0.454 | 0.651 |
| MH | 66.06±10.13 | 64.69±7.63 | 0.867 | 0.387 |
| Total score | 102.93±13.98 | 101.62±12.4 | 0.560 | 0.577 |
[i] Note: BP, bodily pain; GH, general health; MH, mental health; PF, physical function; RE, role emotional, RP, role physical; SF, social function; VT, vitality.
Table 1
Comparison of quality of life between the two groups after discharge (M±SD).
| 1 month after discharge | 3 months after discharge | 6 months after discharge | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Items | Control group (n=57) | Intervention group (n=60) | t | P | Control group (n=57) | Intervention group (n=60) | t | P | Control group (n=57) | Intervention group (n=60) | t | P |
| PF | 67.19+21.02 | 74.5+16.41 | -2.102 | 0.038* | 66.67+20.82 | 74.83+16.23 | -2.373 | 0.019* | 66.75+19.81 | 74.67+14.84 | -2.453 | 0.016* |
| RP | 26.75 + 16.94 | 37.91+26.64 | -2.689 | 0.008* | 28.95+17.54 | 45.42+28.14 | -3.771 | 0.000* | 33.33+21.30 | 48.33+25.57 | -3.438 | 0.001* |
| BP | 56.75+22.70 | 63.33+8.51 | -2.096 | 0.038* | 57.84+21.86 | 64.38+8.12 | -2.163 | 0.033* | 56.93+21.43 | 64.38+9.26 | -2.460 | 0.015* |
| GH | 56.67+8.94 | 52.42+9.54 | 2.484 | 0.014* | 57.63+8.350 | 53.75+8.86 | 2.436 | 0.016* | 57.28+8.51 | 53.58+9.48 | 2.216 | 0.029* |
| VT | 64.21+13.72 | 68.42+7.45 | -2.075 | 0.400 | 64.12+12.79 | 69.42+7.40 | -2.755 | 0.007* | 63.33+11.89 | 69+7.24 | -3.132 | 0.002* |
| SF | 48.46 + 14.38 | 57.29+14.97 | -3.250 | 0.002* | 51.75+13.86 | 60.62+13.58 | -3.496 | 0.001* | 50.66+13.03 | 60.63+12.78 | -4.177 | 0.000* |
| RE | 75.44+29.90 | 85.56+21.58 | -2.106 | 0.037* | 76.61+29.52 | 87.78+18.38 | -2.470 | 0.015* | 76.02+24.20 | 85.56+20.69 | -2.294 | 0.024* |
| MH | 66.53+9.79 | 69.73+7.52 | -1.993 | 0.049* | 67.23+10.07 | 70.30+7.49 | -2.143 | 0.034* | 67.23+10.13 | 10.13+7.00 | -2.022 | 0.046* |
| Total Score | 107.62 + 11.76 | 111.81+8.10 | -2.252 | 0.026* | 108.32+11.30 | 113.29+7.57 | -2.808 | 0.006* | 108.09+10.56 | 113.2+7.08 | -3.086 | 0.003* |