Abstract
Background
There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD.
Methods
We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George’s Respiratory Questionnaire for COPD patients, Impact domain; score 0–100; minimal clinically important difference = − 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1–4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals.
Results
Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = − 12.75; 95% confidence interval − 18.79 to − 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23–0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01–0.23; p = 0.0293).
Conclusions
Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits.
Clinical Trials Registration No
NCT02870998.
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Data Availability
All quantitative data analyzed during this study in this article are provided as Electronic Supplementary Materials. Audio-visual datasets analyzed during the current study are not publicly available because of confidentially issues.
References
Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health. 2015;5(2):020415. https://doi.org/10.7189/jogh.05-020415.
GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691–706. https://doi.org/10.1016/s2213-2600(17)30293-x.
Lopez-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology. 2016;21(1):14–23. https://doi.org/10.1111/resp.12660PubMed PMID: 26494423.
Mannino DM, Higuchi K, Yu TC, Zhou H, Li Y, Tian H, et al. Economic burden of COPD in the presence of comorbidities. Chest. 2015;148(1):138–50. https://doi.org/10.1378/chest.14-2434.
Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–9. https://doi.org/10.1016/S2213-2600(15)00241-6.
Miller J, Edwards LD, Agusti A, Bakke P, Calverley PM, Celli B, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med. 2013;107(9):1376–84. https://doi.org/10.1016/j.rmed.2013.05.001.
Brenner DR, Boffetta P, Duell EJ, Bickeboller H, Rosenberger A, McCormack V, et al. Previous lung diseases and lung cancer risk: a pooled analysis from the International Lung Cancer Consortium. Am J Epidemiol. 2012;176(7):573–85. https://doi.org/10.1093/aje/kws151.
Fry JS, Hamling JS, Lee PN. Systematic review with meta-analysis of the epidemiological evidence relating FEV1 decline to lung cancer risk. BMC Cancer. 2012;12:498. https://doi.org/10.1186/1471-2407-12-498.
Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res. 2013;5:235–45. https://doi.org/10.2147/CEOR.S34321.
Hermus G, Stonebridge C, Goldfarb D, Thériault L, Bounajm F. Cost risk analysis for chronic lung disease in Canada: The Conference Board of Canada; 2012. https://www.conferenceboard.ca/. Accessed 3 Sept 2019.
Dekhuijzen R, Lavorini F, Usmani OS, van Boven JFM. Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: where do we go from here? J Allergy Clin Immunol Pract. 2018;6(3):785–93. https://doi.org/10.1016/j.jaip.2017.11.027.
Lewis A, Torvinen S, Dekhuijzen PN, Chrystyn H, Watson AT, Blackney M, et al. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Serv Res. 2016;16:251. https://doi.org/10.1186/s12913-016-1482-7.
Pearce G, Parke HL, Pinnock H, Epiphaniou E, Bourne CLA, Sheikh A, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. J Health Serv Res Policy. 2016;21(2):73–82. https://doi.org/10.1177/1355819615602725.
Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017. https://doi.org/10.1183/13993003.00214-2017.
Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014;3(3):CD002990. https://doi.org/10.1002/14651858.cd002990.pub3.
Kruis AL, Boland MR, Assendelft WJ, Gussekloo J, Tsiachristas A, Stijnen T, et al. Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial. BMJ. 2014;349:g5392. https://doi.org/10.1136/bmj.g5392.
Gui J, Titova E, Salvesen Ø, Bentsen SB, Sunde S, Steinshamn S, et al. Does an integrated care intervention for COPD patients have long-term effects on quality of life and patient activation? A prospective, open, controlled single-center intervention study. PLoS One. 2017;12(1):e0167887. https://doi.org/10.1371/journal.pone.0167887.
Collinsworth AW, Brown RM, James CS, Stanford RH, Alemayehu D, Priest EL. The impact of patient education and shared decision making on hospital readmissions for COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:1325–32. https://doi.org/10.2147/COPD.S154414.
Fan VS, Gaziano JM, Lew R, Bourbeau J, Adams SG, Leatherman S, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Ann Intern Med. 2012;156(10):673–83. https://doi.org/10.7326/0003-4819-156-10-201205150-00003.
Bourbeau J, Lavoie KL, Sedeno M. Comprehensive self-management strategies. Semin Respir Crit Care Med. 2015;36(4):630–8. https://doi.org/10.1055/s-0035-1556059.
Effing TW, Vercoulen JH, Bourbeau J, Trappenburg J, Lenferink A, Cafarella P, et al. Definition of a COPD self-management intervention: International Expert Group consensus. Eur Respir J. 2016;48(1):46–54. https://doi.org/10.1183/13993003.00025-2016.
de Bruin M, Dima AL, Texier N, van Ganse E, ASTRO-LAB Group. Explaining the amount and consistency of medical care and self-management support in asthma: a survey of primary care providers in France and the United Kingdom. J Allergy Clin Immunol Pract. 2018;6(6):1916.e72018–1925.e72018. https://doi.org/10.1016/j.jaip.2018.04.039.
López-Viña A, Giner J, Molina J, Palicio J, Plaza J, Quintano JA, et al. Multidisciplinary consensus on the nonadherence to clinical management of inhaled therapy in Spanish asthma patients. Clin Ther. 2017;39(8):1730.e1–1745.e1. https://doi.org/10.1016/j.clinthera.2017.06.010.
Pinnock H, Epiphaniou E, Pearce G, Parke H, Greenhalgh T, Sheikh A, et al. Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies. BMC Med. 2015;13(1):127. https://doi.org/10.1186/s12916-015-0361-0.
Boulet LP, Côté P, Bourbeau J. The Quebec Asthma and COPD Network (QACN): a model of integration of the therapeutic education into care. Ther Patient Educ. 2014;6(1):10301. https://doi.org/10.1051/tpe/2014001.
Bourbeau J, Farias R, Li PZ, Gauthier G, Battisti L, Chabot V, et al. The Quebec Respiratory Health Education Network: integrating a model of self-management education in COPD primary care. Chron Respir Dis. 2018;15(2):103–13. https://doi.org/10.1177/1479972317723237.
Boulet LP, Boulay ME, Gauthier G, Battisti L, Chabot V, Beauchesne MF, et al. Benefits of an asthma education program provided at primary care sites on asthma outcomes. Respir Med. 2015;109(8):991–1000. https://doi.org/10.1016/j.rmed.2015.05.004.
Gagne M, Moisan J, Lauzier S, Hamel C, Cote P, Bourbeau J, et al. Comparative impact of two continuing education activities targeted at COPD educators on educational outcomes: protocol for a non-randomized controlled study using mixed methods. BMC Health Serv Res. 2018;18(1):460. https://doi.org/10.1186/s12913-018-3284-6.
Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. 2009;29(1):1–15. https://doi.org/10.1002/chp.20001.
O’Donnell DE, Hernandez P, Kaplan A, Aaron S, Bourbeau J, Marciniuk D, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease: 2008 update: highlights for primary care. Can Respir J. 2008;15(Suppl. A):1A–8A. https://doi.org/10.1155/2008/641965.
Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR, Goodridge D, Hernandez P, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic society guideline. Chest. 2015;147(4):894–942. https://doi.org/10.1378/chest.14-1676.
GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2018 [cited 2018 May 25]. www.goldcopd.org. Accessed 3 Sept 2019.
Bourbeau J, Maltais F, Rouleau M, Guimont C. French-Canadian version of the Chronic Respiratory and St George’s Respiratory questionnaires: an assessment of their psychometric properties in patients with chronic obstructive pulmonary disease. Can Respir J. 2004;11(7):480–6. https://doi.org/10.1155/2004/702421.
Meguro M, Barley EA, Spencer S, Jones PW. Development and validation of an improved, COPD-specific version of the St. George Respiratory Questionnaire. Chest. 2007;132(2):456–63. https://doi.org/10.1378/chest.06-0702.
Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation: the St. George’s Respiratory Questionnaire. Am Rev Respir Dis. 1992;145(6):1321–7. https://doi.org/10.1164/ajrccm/145.6.1321.
Pinto LM, Gupta N, Tan W, Li PZ, Benedetti A, Jones PW, et al. Derivation of normative data for the COPD assessment test (CAT). Respir Res. 2014;15:68. https://doi.org/10.1186/1465-9921-15-68.
Jones PW. St. George’s Respiratory Questionnaire: MCID. COPD. 2005;2(1):75–9. https://doi.org/10.1081/copd-200050513.
Kon SS, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ, et al. Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. Lancet Respir Med. 2014;2(3):195–203. https://doi.org/10.1016/S2213-2600(14)70001-3.
Jones PW, Rennard S, Tabberer M, Riley JH, Vahdati-Bolouri M, Barnes NC. Interpreting patient-reported outcomes from clinical trials in COPD: a discussion. Int J Chron Obstruct Pulmon Dis. 2016;11:3069–78. https://doi.org/10.2147/COPD.S117378.
Statistics Canada. Survey on living with chronic conditions in Canada (SLCDC): respiratory component: 2011 Questionnaire Ottawa: Statistics Canada; 2011 [cited 2016 August 30]. http://www23.statcan.gc.ca/imdb-bmdi/instrument/5160_Q6_V1-eng.pdf. Accessed 3 Sept 2019.
Maunsell E, Lauzier S, Brunet J, Pelletier S, Osborne RH, Campbell HS. Health-related empowerment in cancer: validity of scales from the Health Education Impact Questionnaire. Cancer. 2014;120(20):3228–36. https://doi.org/10.1002/cncr.28847.
Schuler M, Musekamp G, Faller H, Ehlebracht-Konig I, Gutenbrunner C, Kirchhof R, et al. Assessment of proximal outcomes of self-management programs: translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ). Qual Life Res. 2013;22(6):1391–403. https://doi.org/10.1007/s11136-012-0268-6.
Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns. 2007;66(2):192–201. https://doi.org/10.1016/j.pec.2006.12.002.
Elsworth GR, Nolte S, Osborne RH. Factor structure and measurement invariance of the Health Education Impact Questionnaire: does the subjectivity of the response perspective threaten the contextual validity of inferences? SAGE Open Med. 2015;3:2050312115585041.
Belanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the Health Education Impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes. 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0.
Kotecha D, Ahmed A, Calvert M, Lencioni M, Terwee CB, Lane DA. Patient-reported outcomes for quality of life assessment in atrial fibrillation: a systematic review of measurement properties. PLoS One. 2016;11(11):e0165790. https://doi.org/10.1371/journal.pone.0165790.
Elsworth GR, Osborne RH. Percentile ranks and benchmark estimates of change for the Health Education Impact Questionnaire: normative data from an Australian sample. SAGE Open Med. 2017. https://doi.org/10.1177/2050312117695716.
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–12. https://doi.org/10.4103/2229-3485.83221.
Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. 2nd ed. Hoboken: Wiley; 2011. p. 701 (xxv).
Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Linear regression. Regression methods in biostatistics: linear, logistic, survival, and repeated measures models. Statistics for biology and health. 2nd ed. New York: Springer; 2012. p. 69–131.
Rothman KJ, Greenland S, Lash TL. Modern epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
Francke AL, Garssen B, Huijer Abu-Saad H. Determinants of changes in nurses’ behaviour after continuing education: a literature review. J Adv Nurs. 1995;21(2):371–7. https://doi.org/10.1111/j.1365-2648.1995.tb02536.x.
Guskey TR. Does it make a difference? Evaluating professional development. Educ Leadersh. 2002;59(6):45–51.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. https://doi.org/10.1016/j.nedt.2003.10.001.
Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 4th ed. Thousand Oaks: SAGE Publications; 2014. p. 273 (xxix).
Newell DJ. Intention-to-treat analysis: implications for quantitative and qualitative research. Int J Epidemiol. 1992;21(5):837–41.
Moullec G, Favreau H, Lavoie KL, Labrecque M. Does a self-management education program have the same impact on emotional and functional dimensions of HRQoL? COPD. 2012;9(1):36–45. https://doi.org/10.3109/15412555.2011.635729.
McCleary N, Andrews A, Buelo A, Captieux M, Morrow S, Wiener-Ogilvie S, et al. IMP(2)ART systematic review of education for healthcare professionals implementing supported self-management for asthma. NPJ Prim Care Respir Med. 2018;28(1):42. https://doi.org/10.1038/s41533-018-0108-4.
Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupre A, Begin R, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163(5):585–91. https://doi.org/10.1001/archinte.163.5.585.
Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med. 2017;15(1):64. https://doi.org/10.1186/s12916-017-0823-7.
Bourbeau J, Collet JP, Schwartzman K, Ducruet T, Nault D, Bradley C. Economic benefits of self-management education in COPD. Chest. 2006;130(6):1704–11. https://doi.org/10.1378/chest.130.6.1704.
Driesenaar JA, De Smet PAGM, van Hultend R, Noordman J, van Dulmen S. Cue-responding behaviors during pharmacy counseling sessions with patients with asthma about inhaled corticosteroids: potential relations with medication beliefs and self-reported adherence. Health Commun. 2016;31(10):1266–75. https://doi.org/10.1080/10410236.2015.1062974.
Driesenaar JA, De Smet PA, van Hulten R, Hu L, van Dulmen S. Communication during counseling sessions about inhaled corticosteroids at the community pharmacy. Patient Prefer Adherence. 2016;10:2239–54. https://doi.org/10.2147/PPA.S108006.
Schön DA. The reflective practitioner: how professionals think in action. New York: Routledge; 2016, 1991, 1983.
Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009;14(4):595–621. https://doi.org/10.1007/s10459-007-9090-2PubMed PMID: 18034364.
Pinsky LE, Monson D, Irby DM. How excellent teachers are made: reflecting on success to improve teaching. Adv Health Sci Educ Theory Pract. 1998;3(3):207–15. https://doi.org/10.1023/A:1009749323352.
Plant J, Li ST, Blankenburg R, Bogetz AL, Long M, Butani L. Reflective practice in the clinical setting: a multi-institutional qualitative study of pediatric faculty and residents. Acad Med. 2017;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S75–83. https://doi.org/10.1097/acm.0000000000001910.
Clari M, Matarese M, Alvaro R, Piredda M, De Marinis MG. Measurement properties of instruments evaluating self-care and related concepts in people with chronic obstructive pulmonary disease: a systematic review. Heart Lung. 2016;45(5):441–8. https://doi.org/10.1016/j.hrtlng.2016.06.006.
Clari M, Matarese M, Ivziku D, De Marinis MG. Self-care of people with chronic obstructive pulmonary disease: a meta-synthesis. Patient. 2017;10(4):407–27. https://doi.org/10.1007/s40271-017-0218-z.
Stacey D, Legare F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431. https://doi.org/10.1002/14651858.cd001431.pub5.
Grady MP. Qualitative and action research: a practitioner handbook. Bloomington: Phi Delta Kappa Educational Foundation; 1998.
Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907. https://doi.org/10.1007/s11135-017-0574-8.
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–12. https://doi.org/10.1056/nejmoa021322.
Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(6):1856–61. https://doi.org/10.1164/ajrccm.160.6.9902115.
Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93(3):580–6. https://doi.org/10.1378/chest.93.3.580.
O’Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease: 2007 update. Can Respir J. 2007;14(Suppl. B):5B–32B. https://doi.org/10.1155/2007/830570.
Gibbons CJ, Mills RJ, Thornton EW, Ealing J, Mitchell JD, Shaw PJ, et al. Rasch analysis of the Hospital Anxiety and Depression Scale (HADS) for use in motor neurone disease. Health Qual Life Outcomes. 2011;9(1):82. https://doi.org/10.1186/1477-7525-9-82.
Acknowledgements
The authors thank Alexandra Lauzier, M.Sc., Patricia Côté, M.A., and Justine Veilleux, undergraduate medical student, for help in data collection. They wish to thank Serge Simard, M.Sc. for assistance in conducting statistical analyses and Stéphanie Charest, M.Sc. Ph.D.(c) for performing the qualitative data analysis. We are grateful to Barbara Pattison, C. Tr. for translating verbatim transcripts from French to English and to Erica Pridoehl, M.Ed. for editing the manuscript. Finally, the authors wish to thank all respiratory educators and adults with COPD who kindly volunteered their time to participate in the present study.
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MG, SL, CH, JB, JM, and LPB contributed to the study design. MG, JBT, and SEP participated in participant recruitment and/or data collection. MG conducted statistical analyses and participated, along with CH, to qualitative analyses. All authors contributed to data interpretation. M.G. wrote the initial draft and SL, CH, JBT, SEP, JB, JM, and LPB revised it for important intellectual content. All authors have given final approval of the version to be published. MG and LPB have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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The Laval University Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health funded the study. For the development and deployment of the training, the Université Laval Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health received funding from the GlaxoSmithKline Medical Education Support Program (the program funds were not used in connection with the research). As part of her doctoral studies, Myriam Gagné received a scholarship from the Fonds de recherche du Québec – Santé to conduct the present study.
Conflict of interest
The authors alone are responsible for the content and writing of this paper. The Université Laval Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health is supported by unrestricted grants from AstraZeneca. The Chair has received funding from GlaxoSmithKline for the development and deployment of the educational component. The program funds were not used in connection with the research. The funding body had no role in the study design, collection, analysis, or interpretation of the data. The publication of our study results will not be contingent on our sponsor’s approval or censorship of the manuscript. The Québec Respiratory Health Education Network is supported by unrestricted grants from AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, and Novartis. Myriam Gagné, Sophie Lauzier, Justine Babineau-Therrien, Christine Hamel, Sara-Edith Penney, Jean Bourbeau, and Jocelyne Moisan have no conflicts of interest that are directly relevant to the content of this article. Louis-Philippe Boulet declares the following potential conflicts of interest—last 3 years: Research grants for participation to multicenter studies: AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi, Takeda. Support for research projects introduced by the investigator: AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Takeda. Consulting and advisory boards: Astra Zeneca, Novartis, Methapharm. Royalties: Co-author of “Up-To-Date” (occupational asthma). Non-profit grants for production of educational materials: AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis. Conference fees: AstraZeneca, GlaxoSmithKline, Merck, Novartis. Support for participation in conferences and meetings: Novartis, Takeda.
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The trial has been approved by the Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval Ethics Committee (Approval number: MP-10-2016-2591).
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Informed consent was obtained from all participants included in the study.
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Gagné, M., Lauzier, S., Babineau-Therrien, J. et al. COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study. Patient 13, 103–119 (2020). https://doi.org/10.1007/s40271-019-00386-7
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DOI: https://doi.org/10.1007/s40271-019-00386-7