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Pre/Post Pilot Test of Video Module Education (Pilot VME)

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ClinicalTrials.gov Identifier: NCT02278237
Recruitment Status : Completed
First Posted : October 29, 2014
Last Update Posted : May 6, 2016
Sponsor:
Information provided by (Responsible Party):
University of Chicago

Brief Summary:

Asthma and Chronic obstructive pulmonary disease (COPD) results in over a million hospitalizations in the United States annually1 and COPD is the third leading cause of 30-day re-hospitalizations.2 Clinical trials have established the efficacy of treatments primarily dispensed via respiratory inhaler devices that reduce morbidity and health care utilization if they are used correctly.3-4 Unfortunately, the effectiveness of these medications in real-world settings is limited by the fact that patients often do not use inhalers correctly.5-6 Current guidelines recommend assessing and teaching inhaler technique at all health care encounters, including hospitalization.77.5 My work has found that over 75% of hospitalized patients in an urban, predominantly underserved population misuse their respiratory inhalers, highlighting a missed opportunity to educate these patients with high potential to benefit.8 Hospitalization, therefore, provides a potential 'teachable moment' to correct this misuse.9 My preliminary data indicate that one strategy, in-person teach-to-goal (TTG), is effective in teaching hospitalized patients proper inhaler technique and is more effective than simple verbal instruction.10

While TTG is a promising method to improve care for patients who use inhalers, several limitations prevent widespread adoption. First, TTG relies on in-person assessment and education, as well as training and monitoring instructors to ensure fidelity, making it time-consuming and costly. Also, because a single educational session does not ensure long-term retention,11-12 post-discharge reinforcement may be needed, which may be impractical with in-person TTG. One potential method to surmount TTG's limitations is use of interactive video module education (VME), a method that has been used for health education in other clinical contexts.13-14 Through iterative self-assessments and video-demonstrations on a tablet computer, VME has the potential to be less costly, maintain fidelity, and be more easily extended into the post-discharge setting than in-person TTG. However, certain questions remain about VME. It is unclear whether VME will yield similar results when compared to TTG, or whether urban, underserved patients will have the ability to, and be willing to use, VME in the post-discharge setting. Therefore, before widespread implementation of VME, it is critical to rigorously develop and test VME for inhaler education in the hospital setting. Ultimately, it will also be important to understand patients' ability and willingness to use post-discharge VME for educational reinforcement to allow for this strategy to transition patients across care settings from hospital to home. Through these funded projects, I will acquire critical data I need to develop R-01 studies focused on improving self-management for patients with obstructive pulmonary disease across care transitions.

We hypothesize that interactive VME will lead to non-inferior rates of ability to demonstrate correct inhaler use compared to rates with TTG among hospitalized patients with Asthma or COPD.

For this study we are testing the preliminary efficacy of VME to teach respiratory inhaler technique prior to implementing a larger RCT to test the comparative effectiveness of VME versus TTG.


Condition or disease Intervention/treatment Phase
Chronic Obstructive Pulmonary Disease Asthma Behavioral: Video Module Education (VME) Not Applicable

Detailed Description:

The specific aim to test this hypothesis is:

To iteratively test VME to teach correct use of metered dose inhaler (MDIs) and dry-powder Diskus® devices to hospitalized patients with Asthma or COPD. We partnered with software development companies to develop VME modules that (self)-assess and teach respiratory inhaler technique to hospitalized participants. We have tested the VME in focus groups. Now that the VME is developed we will iteratively pilot test (n=30-40) the VME strategy (up to 3 rounds (90-120 total)) to obtain important patient feedback,preferences and preliminary efficacy estimates for the module.

We hypothesize that participants' post-VME inhaler technique will be significantly better than their pre-VME inhaler technique.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 90 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Pre/Post Pilot Test of VME for the Video vs. TTG Respiratory Inhaler Technique Assessment and InstructioN Study
Study Start Date : November 2014
Actual Primary Completion Date : October 2015
Actual Study Completion Date : October 2015

Arm Intervention/treatment
Experimental: VME Group Behavioral: Video Module Education (VME)



Primary Outcome Measures :
  1. the proportion of participants with MDI misuse post VME vs. pre VME. This will provide data on the short-term efficacy of VME. [ Time Frame: Up to 30 days ]

    Assess patient's inhaler technique using Inhaler checklists by the trained assessor.

    The primary outcome will be comparing post-intervention to pre-intervention scores; secondary outcome will be 30 days post-discharge visit

    We will define inhaler technique in two ways:

    1. Correct Use (i.e., >75% of steps correct)
    2. Mastery (i.e., perfect technique, 100% steps correct)


Secondary Outcome Measures :
  1. Symptom burden [ Time Frame: up to 30 days ]
    Assess patient's respiratory symptoms/morbidity, which includes the Borg symptom score, Asthma Symptom Severity Index (ASSI), Chronic Bronchitis Symptom Questionnaire, COPD Severity Score (CSS), Airway Questionnaire (AQ-20), COPD Helplessness Index (CHI) and demographic and other clinical information.

  2. Quality of Life (QOL) [ Time Frame: up to 30 days ]
    Use validated disease specific QOL tools (i.e., asthma or COPD QOL tools)

  3. Self-efficacy of inhaler technique [ Time Frame: up to 30 days ]

    Assess patient's confidence in using their inhalers.

    We will ask patients to report if they: strongly disagree/disagree/neutral/agree/strongly agree with the statement: "I am confident that I know how to use this respiratory inhaler correctly".




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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age 18 years and older
  2. Admission to the inpatient medical service and surgical service
  3. Physician-diagnosed COPD or asthma. We will enroll patients even if the primary reason for admission is not COPD or asthma (e.g., patients admitted for heart failure, but with a physician diagnosis of COPD are eligible).

Exclusion Criteria:

  1. Currently in an intensive care unit
  2. Physician declines to provide consent
  3. Patient unable to provide consent (e.g., history of cognitive impairment, unable to understand English) or declines to provide consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02278237


Sponsors and Collaborators
University of Chicago
Investigators
Principal Investigator: Valerie G. Press, MD, MPH University of Chicago

Responsible Party: University of Chicago
ClinicalTrials.gov Identifier: NCT02278237     History of Changes
Other Study ID Numbers: IRB12-1844
First Posted: October 29, 2014    Key Record Dates
Last Update Posted: May 6, 2016
Last Verified: May 2016

Additional relevant MeSH terms:
Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Respiratory Tract Diseases