An effıcıent approach to care cost effectıveness ın patıents dıagnosed wıth stable COPD: Patıent coachıng<p> Stabil KOAH tanılı hastalarda bakım maliyet etkinliği üzerine etkili bir yaklaşım: Hasta koçluğu
Keywords:
Patient Coaching, Chronic Obstructive Pulmonary Disease, Cost of Care, Nursing, Hasta Koçluğu, Kronik Obstrüktif Akciğer Hastalığı, Bakım Maliyeti, HemşirelikAbstract
Chronic Obstructive Pulmonary Disease is a disease characterized by chronic asthma, bronchitis, and interstitial pulmonary diseases. The most frequent and ever-exacerbating symptoms of the disease involve dyspnea, cough, sputum, loss of appetite, fatigue, anxiety, and depression. As the incidence, severity and distress of symptoms accelarate; treatment and care needs of patients also increase. Increasing treatment and care needs in the process of disease and adherence to treatment have a negative effect on the care cost. Patient coaching is an approach that will make an important contribution to the increase of adherence to treatment and disease and the decrease of care cost by developing the symptom management and self-care skills of patients.
Özet
Kronik obstrüktif akciğer hastalığı (KOAH); kronik astım, bronşit ve interstisyel akciğer hastalıkları ile karakterize bir hastalıktır. Hastalıkta en sık karşılaşılan ve şiddeti giderek artan semptomlar, dispne, öksürük, balgam, iştahsızlık, yorgunluk, anksiyete ve depresyondur. Semptomların görülme oranı, şiddeti ve bireyde yarattığı stres düzeyi arttıkça hastaların tedavi ve bakım gereksinimlerinde de artış görülmektedir. Hastalık ve tedaviye uyum sürecinde artan tedavi ve bakım gereksinimleri bakım maliyetini olumsuz yönde etkilemektedir. Hasta koçluğu, hastaların semptom yönetimi ve öz bakım becerilerini geliştirerek hastalığa ve tedaviye uyumunun artmasında ve bakım maliyetinin düşmesinde önemli katkı sağlayacak olan bir yaklaşımdır.
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Acar A,Yeğenoğlu S. (2006). Sağlık Ekonomisi Perspektifinden Farmakoekonomi. Hacettepe Üniversitesi, Eczacılık Fakültesi Dergisi Cilt 26, Sayı 1, Ocak, ss. 39-55
Antoniu SA, Ungureanu D. (2015). Measuring fatigue as a symptom in COPD: From descriptors and questionnaires to the importance of the problem. Chronic Respiratory Disease, Vol. 12(3) 179–188. doi: 10.1177/1479972315575716.
Baraniak A, Sheffield D. (2011). The efficacy of psychologically based interventions to improve anxiety, depression and quality of life in COPD: A systematic review and meta-analysis. Patient Education and Counseling 83, 29–36. doi: 10.1016/j.pec.2010.04.010.
Barnett M. (2011). How to effectively manage COPD in care home residents. Nursing & Residential Care December, Vol 13, No 12. DOI: http://dx.doi.org/10.12968/nrec.2011.13.12.578
Berkhof FF, Boom LN, Hertog NE, Uil SM, Kerstjens HAM, van den Berg JWK. (2012). The Validity and Precision of The Leicester Cough Questionnaire in COPD Patients with Chronic Cough. Health Qual Life Outcomes. Jan 9;10:4. doi: 10.1186/1477-7525-10-4.
Boland MRS, Tsiachristas A, Kruis AL, Chavannes NH, Rutten-van Mölken MPMH. (2013). The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis. BMC Pulmonary Medicine. Jul 3;13:40. doi: 10.1186/1471-2466-13-40.
Booker R. (2008). The primary care face of COPD. Primary Health Care. 18, 5,37-47.
Borges-Santos E, Wadaa JT, Marques da Silvaa C, Silvaa RA, Stelmachb R, Carvalhoa CR et al. (2015). Anxiety and Depression are Related to Dyspnea and Clinical Control but not with Thoracoabdominal Mechanics in Patients With COPD Respiratory Physiology&Neurobiology 210, 1–6. doi:10.1016/j.resp.2015.01.011
Bustacchini S, Chiatti C, Furneri G, Lattanzio F, Mantovani LG. (2011). The economic burden of chronic obstructive pulmonary disease in the elderly: results from a systematic review of the literature. Curr Opin Pulm Med.Dec;17 Suppl 1:S35-41. doi: 10.1097/01.mcp.0000410746.82840.79.
Chiang CH. (2008). Cost analysis of chronic obstructive pulmonary disease in a tertiary care setting in Taiwan. Respirology. Sep;13(5):689-94. doi: 10.1111/j.1440-1843.2008.01308.x.
Christenhusz LC, Prenger R, Pieterse ME, Seydel ER, van der Palen J. (2012). Cost-effectiveness of an intensive smoking cessation intervention for COPD outpatients. Nicotine Tob Res. Jun;14(6):657-63. doi: 10.1093/ntr/ntr263.
Dal Negro RW, Tognella S, Tosatto R, Dionisi M, Turco P, Donner CF. (2008). Costs of chronic obstructive pulmonary disease (COPD) in Italy: the SIRIO study (social impact of respiratory integrated outcomes). Respir Med. Jan;102(1):92-101. doi:10.1016/j.rmed.2007.08.001
De Bruin SR, Heijink R, Lemmens LC, Struijs JN, Baan CA. (2011). Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: a systematic review of the literature. Health Policy. Jul;101(2):105-21. doi: 10.1016/j.healthpol.2011.03.006.
Desveaux L, Janaudis-Ferreira T, Goldstein R, Brooks D. (2015). An International Comparison of Pulmonary Rehabilitation: A Systematic Review. COPD. Apr;12(2):144-53. doi: 10.3109/15412555.2014.922066.
Disler RT, Green A, Luckett T, Newton PJ, Inglis S, Currow DC, Davidson PM. (2014). Experience of advanced chronic obstructive pulmonary disease: metasynthesis of qualitative research. J Pain Symptom Manage. Dec;48(6):1182-99. doi: 10.1016/j.jpainsymman.2014.03.009.
Drummond MF, Aguiar-Ibanez R, Nixon J. (2006) Economic Evaluation. Singapore Medical Journal, 47(6): 456-462.
Dwinger S, Dirmaier J, Herbarth L, König HH, Eckardt M, Kriston L, et al. (2013). Telephone-Based Health Coaching for Chronically İll Patients: Study Protocol for A Randomized Controlled Trial. Trials. Oct 17;14:337. doi: 10.1186/1745-6215-14-337.
Eckerblad J, Tödt K, Jakobsson P, Unosson M, Skargren E, Kentsson M, Theander K. (2014). Symptom burden in stable COPD patients with moderate or severe airflow limitation. Heart Lung. Jul-Aug;43(4):351-7. doi: 10.1016/j.hrtlng.2014.04.004.
Fletcher MJ, DahP BH. (2013). Expanding nurse practice in COPD: is it key to providing high quality, effective and safe patient care? Prim Care Respir J. Jun;22(2):230-3. doi: 10.4104/pcrj.2013.00044
Gabriel R, Figueiredo D, Jácome C, Cruz J, Marques A. (2014). Day-to-day living with severe chronic obstructive pulmonary disease: Towards a family-based approach to the illness impacts. Psychology & Health, Vol. 29, No. 8, 967–983, http://dx.doi.org/10.1080/08870446.2014.902458
Garrow AP, Yorke J, Khan N, Vestbo J, Singh D, Tyson S. (2015). Systematic literature review of patient-reported outcome measures used in assessment and measurement of sleep disorders in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. Feb 9;10:293-307. doi: 10.2147/COPD.S68093.
Geiger-Brown J, Lipscomb J. (2010). The health care work environment and adverse health and safety consequences for nurses. Annu Rev Nurs Res. 28:191-231. DOI: http://dx.doi.org/10.1891/0739-6686.28.191
Geitona M, Hatzikou M, Steiropoulos P, Alexopoulos EC, Bouros D. (2011). The cost of COPD exacerbations: A university hospital e based study in Greece. Respiratory Medicine. 105, 402e409. doi: 10.1016/j.rmed.2010.09.020.
Gillespie P, O’Shea E, Casey D, Murphy K, Devane D, Cooney A, et al. (2013). The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial. BMJ Open. 3:e003479. doi:10.1136/bmjopen-2013-003479
Greening NJ, Williams JEA, Hussain SF, Harvey-Dunstan TC, Bankart MJ, Chaplin EJ, et al. (2014). An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ. 349:g4315 doi: 10.1136/bmj.g4315
Haroon S, Adab P, Griffin C, Jordan R. (2013). Case finding for chronic obstructive pulmonary disease in primary care: a pilot randomised controlled trial. Br J Gen Pract. Jan;63(606):e55-62. doi: 10.3399/bjgp13X660788.
Henderson C, Knapp M, Fernández JL, Beecham J, Hirani SP, Cartwright M, et al. (2013). Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demostrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ. Mar 20;346:f1035. doi: 10.1136/bmj.f1035.
http://www.who.int/choice/cost-effectiveness/tools/en/ Erişim Tarihi: 08/12/2015
Hyde N, Casey D, Murphy K, Cooney A, Mee L, Kirwan C, et al. (2013) COPD in primary care settings in Ireland: stories from usual care. Br J Community Nurs. Jun;18(6):275-82. DOI: http://dx.doi.org/10.12968/bjcn.2013.18.6.275
Jithoo A, Enright PL, Burney P, Buist AS, Bateman ED, Tan WC, et al. (2013). Case-finding options for COPD: results from the Burden of Obstructive Lung Disease study. Eur Respir J. Mar;41(3):548-55. doi: 10.1183/09031936.00132011.
Kauffman KS, Doede M, Diaz-Abad M, Scharf SM, Bell-Farrell W, Rogers VE, Geiger-Brown J. (2014). Experience of insomnia, symptom attribution and treatment preferences in individuals with moderate to severe COPD: a qualitative study. Patient Prefer Adherence. Dec 10;8:1699-704. doi: 10.2147/PPA.S71666.
Kivelä K, Elo S, Kyngäs H, Kääriäinen M. (2014). The Effects of Health Coaching on Adult Patients with Chronic Diseases: A Systematic Review. Patient Educ Couns. Nov;97(2):147-57. doi: 10.1016/j.pec.2014.07.026.
Kulich K, Keininger DL, Tiplady B, Banerji D. (2015). Symptoms and İmpact of COPD Assessed By An Electronic Diary in Patients with Moderate-to-Severe COPD: Psychometric Results From The SHINE Study. Int J Chron Obstruct Pulmon Dis. Jan 7;10:79-94. doi: 10.2147/COPD.S73092
Lee H, Yoon JY, Lim Y, Jung H, Kim S, Yoo Y, et al. (2015). The effect of nurse-led problem-solving therapy on coping, self-efficacy and depressive symptoms for patients with chronic obstructive pulmonary disease: a randomised controlled trial. Age Ageing. May;44(3):397-403. doi: 10.1093/ageing/afu201.
Lenferink A, Frith P, Valk P, Buckman J, Sladek R, Cafarella P, et al. (2013). A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: The COPE-III study protocol. Contemporary Clinical Trials 36, 81–89. doi: 10.1016/j.cct.2013.06.003.
Lindena K, Jormanainenb V, Linnac M, Sintonend H, Wilsone K, Kotomäkia T.(2010). Cost effectiveness of varenicline versus bupropion and unaided cessation for smoking cessation in a cohort of Finnish adult smokers. Current Medical Research and Opinion, 26:3, 549-560, DOI: 10.1185/03007990903542666
Lock K, Wilson K, Murphy D, Riesco JA. (2011). A cost-effectiveness model of smoking cessation based on a randomised controlled trial of varenicline versus placebo in patients with chronic obstructive pulmonary disease. Expert Opin. Pharmacother. Dec;12(17):2613-26. doi: 10.1517/14656566.2011.628935
Lohne V, Heer HC, Andersen M, Miaskowski C, Kongerud J, Rustøen T. (2010). Qualitative study of pain of patients with chronic obstructive pulmonary disease. Heart Lung. May-Jun;39(3):226-34. doi: 10.1016/j.hrtlng.2009.08.002.
Mauskopf JA, Baker CL, Monz BU, Juniper MD. (2010). Cost effectiveness of tiotropium for chronic obstructive pulmonary disease: a systematic review of the evidence. J Med Econ. 13(3):403-17. doi: 10.3111/13696998.2010.499813.
McCarthy C, Brennan JR, Brown L, Donaghy D, Jones P, Whelan R, et al. (2013). Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study. International Journal of COPD 2013:8. doi: 10.2147/COPD.S52883.
Medland J, Stern M. (2009). Coaching as a successful strategy for advancing new manager competency and performance. J Nurses Staff Dev. May-Jun;25(3):141-7. doi: 10.1097/NND.0b013e3181a56f0a
Miravitlles M, Worth H, SolerCataluña JJ, Price D, De Benedetto F, Roche N, et al. (2014). Observational Study to Characterise 24-Hour COPD Symptoms and Their Relationship with Patient-Reported Outcomes: Results From The ASSESS Study. Respir Res. Oct 21;15(1):122. doi: 10.1186/s12931-014-0122-1.
Miravitlles M. (2011). Cough and Sputum Production As Risk Factors for Poor Outcomes in Patients with COPD Respiratory Medicine, 105, 1118-1128. doi:10.1016/j.rmed.2011.02.00
Mitchell GJ, Cross N, Wilson M, Biernacki S, Wong W, Adib B, Rush D. (2013). Complexity and health coaching: synergies in nursing. Nurs Res Pract. 2013:238620. doi: 10.1155/2013/238620.
Mitchell KE, Johnson-Warrington V, Apps LD, Bankart J, Sewell L, Williams JE, et al. (2014). A self-management programme for COPD: a randomised controlled trial. Eur Respir J. 44: 1538–1547, DOI: 10.1183/09031936.00047814
Moriyama M, Takeshita Y, Haruta Y, Hattori N, Ezenwaka CE. (2015). Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy. Rehabil Nurs. Jan-Feb;40(1):40-51. doi: 10.1002/rnj.119.
Nielsen R, Johannessen A, Omenaas ER, Bakke PS, Askildsen JE, Gulsvik A. (2011). Excessive costs of COPD in ever-smokers. A longitudinal community study. Respir Med. Mar;105(3):485-93. doi: 10.1016/j.rmed.2010.08.009.
Norweg A, Collins EG. (2013). Evidence for cognitive–behavioral strategies improving dyspnea and related distress in COPD. International Journal of COPD. 8 439–451. doi: 10.2147/COPD.S30145.
Özgen H, Tatar M. (2007). Sağlık Sektöründe Bir Verimlilik Değerlendirme Tekniği Olarak Maliyet-Etkililik Analizi ve Türkiye’de Durum. Hacettepe Sağlık İdaresi Dergisi, Cilt:10, Sayı:2
Özkaya Ş, Fındık S, Atıcı AG. (2011). The costs of hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease. Clinicoecon Outcomes Res. 3:15-8. doi: 10.2147/CEOR.S14820.
Park SK. Larson JL. (2015). Multiple symptoms, functioning, and general health perception in people with severe COPD over time. Nursing Research, doi: 10.1016/j.apnr.2015.06.010
Park SK, Larson JR. (2014). Symptom Cluster, Healthcare Use and Mortality in Patients with Severe Chronic Obstructive Pulmonary Disease. J Clin Nurs. September;23(0): 2658–2671. doi:10.1111/jocn.12526.
Pelkonen M, Notkola IL, Nissinen A, Tukiainen H, Koskela H. (2006). Thirty-Year Cumulative İncidence of Chronic Bronchitis and COPD in Relation to 30-Year Pulmonary Function and 40-Year Mortality: A Follow-Up in Middle-Aged Rural Men. Chest. Oct;130(4):1129-37. doi:10.1378/chest.130.4.1129
Perini W, Snijder MB, Schene AH, Kunst AE. (2015). Prevalence of depressive symptoms among patients with a chronic nonspecific lung disease in five ethnic minority groups. Gen Hosp Psychiatry. Nov-Dec;37(6):513-7. doi: 10.1016/j.genhosppsych.2015.08.003.
Philip J, Gold M, Brand C, Miller B, Douglass J, Sundararajan V. (2014). Facilitating change and adaptation: the experiences of current and bereaved carers of patients with severe chronic obstructive pulmonary disease. J Palliat Med. Apr;17(4):421-7. doi:10.1089/jpm.2013.0339.
Punekar YS, Shukla A, Müllerova H. (2014). COPD management costs according to the frequency of COPD exacerbations in UK primary care. Int J Chron Obstruct Pulmon Dis. 9:65-73. doi: 10.2147/COPD.S54417.
Raguso CA, Luthy C. (2011). Nutritional status in chronic obstructive pulmonary disease: Role of hypoxia. Nutrition 27, 138–143. doi: 10.1016/j.nut.2010.07.009
Robles PG, Brooks D, Goldstein R, Salbach N, Mathur S. (2014). Gender-Associated Differences in Pulmonary Rehabilitation Outcomes in People With Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary Rehabilitation and Prevention. 34:87-97. doi: 10.1097/HCR.0000000000000018.
Scano G, Gigliotti F, Stendardi L, Gagliardi E. (2013). Dyspnea and Emotional States in Health and Disease. Respir Med. May;107(5):649-55. doi: 10.1016/j.rmed.2012.12.018.
Shingai K, Kanezaki M, Senjyu H. (2015). Distractive Auditory Stimuli Alleviate the Perception of Dyspnea Induced by Low-Intensity Exercise in Elderly Subjects With COPD. Respir Care;60(5):689-694. DOI: 10.4187/respcare,03533
Sidhu MS, Daley A, Jordan R, Coventry PA, Heneghan C, Jowett S, et al. (2015). Patient Self-Management in Primary Care Patients with Mild COPD - Protocol of A Randomised Controlled Trial of Telephone Health Coaching. BMC PulmMed. Feb 22;15:16. doi: 10.1186/s12890-015-0011-5
Squassoni SD, Machado NC, Lapa MS, Cordoni PK, Bortolassi LC, Oliveira JN, et al. (2014). Comparison Between The 6-Minute Walk Tests Performed in Patients with Chronic Obstructive Pulmonary Disease at Different Altitudes. Einstein (Sao Paulo). Oct-Dec;12(4):447-51. doi: 10.1590/S1679-45082014AO3139
Ståhl E, Lindberg A, Jansson SA, Rönmark E, Svensson K, Andersson F, et al. (2005). Health-Related Quality of Life is Related to COPD Disease Severity. Health Qual Life Outcomes. Sep 9;3:56. doi: 10.1186/1477-7525-3-56
Stenekes SJ, Hughes A, Grégoire MC, Frager G, Robinson WM, McGrath PJ. (2009). Frequency and Self-Management of Pain, Dyspnea, and Cough in Cystic Fibrosis. J Pain Symptomanage. Dec;38(6):837-48. doi: 10.1016/j.jpainsymman.2009.04.029.
Steuten LM, Lemmens KM, Nieboer AP, Vrijhoef HJ. (2009). Identifying potentially cost effective chronic care programs for people with COPD. Int J Chron Obstruct Pulmon Dis. 4:87–100. http://dx.doi.org/10.2147/COPD.S3047
Stridsman C, Skär L, Hedman L, Rönmark E, Lindberg A. (2015). Fatigue Affects Health Status and Predicts Mortality Among Subjects with COPD: Report from the Population-Based OLIN COPD Study. COPD. Apr;12(2):199-206. doi: 10.3109/15412555.2014.922176.
Sunde S, Walstad RA, Bentsen SB, Lunde SJ, Wangen EM, Rustøen T, Henriksen AH. (2014). The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD): the COPD-Home model. Scand J Caring Sci. Sep;28(3):469-77. doi: 10.1111/scs.12069.
Süt N. (2012). Hastalık maliyet analizi. RAED Dergisi;4(1):24-28 RAED, doi:10.2399/raed.12.002
Şahin E, Aytekin A, Tuğ T. (2014).Yaşlı Kronik Obstrüktif Akciğer Hastalarına Verilen Eğitimin İnhalasyon Cihazı Kullanım Becerilerine Etkisi. Turk Toraks Derg. 15: 49-56. DOI: 10.5152/ttd.2013.51
Tabak M, Brusse-Keizer M, van der Valk P, Hermens H, Vollenbroek-Hutten M. (2014). A Telehealth Program for Self-Management of COPD Exacerbations and Promotion of An Active Lifestyle: A Pilot Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis. Sep 9;9:935-44. doi: 10.2147/COPD.S60179.
Terada K, Muro S, Ohara T, Haruna A, Marumo S, Kudo M, et al. (20099. Cough-Reflex Sensitivity to İnhaled Capsaicin in COPD Associated with İncreased Exacerbation Frequency. Respirology, 14, 1151–1155 doi: 10.1111/j.1440-1843.2009.01620.x
Tödt K, Skargren E, Kentson M, Theander K, Jakobsson P, Unosson M. (2014). Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD. Int J Chron Obstruct Pulmon Dis. 9:17-25. doi: 10.2147/COPD.S52506.
Türk Toraks Derneği (2010). KOAH Tanı ve Tedavi Uzlaşı Raporu. www.toraks.org.tr
Upton J, Madoc-Sutton H, Loveridge C, Sheikh A, Walker S, Fletcher M. (2010). Assessment of psychosocial problems in primary care COPD patients. Br J Nurs. May 13-26;19(9):554-7. DOI: http://dx.doi.org/10.12968/bjon.2010.19.9.48053
Utens CM, van Schayck OC, Goossens LM, Rutten-van Mölken MP, DeMunck DR, Seezink W, et al. (2014). Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial. Int J Nurs Stud. Aug;51(8):1093-102. doi: 10.1016/j.ijnurstu.2014.01.002.
Vale MJ, Jelinek MV, Best JD, Dart AM, Grigg LE, Hare DL, et al. (2003). Coaching Patients on Achieving Cardiovascular Health (COACH): A Multicenter Randomized Trial in Patients with Coronary Heart Disease. Arch Intern Med. Dec 8-22;163(22):2775-83. doi:10.1001/archinte.163.22.2775.
Verbrugge R, Boer F, Georges JJ. (2013). Strategies used by respiratory nurses to stimulate self-management in patients with COPD. Journal of Clinical Nursing, Oct;22(19-20):2787-99. doi: 10.1111/jocn.12048
Voll-Aaneruda M, Eagana TM, Wentzel-Larsenb T, Gulsvikc A, Bakkea PS. (2008). Respiratory symptoms, COPD severity, and health related quality of life in a general population sample. Respiratory Medicine, 102, 399–406. DOI: http://dx.doi.org/10.1016/j.rmed.2007.10.012
Walters J. (2010). COPD - Diagnosis, Management and the Role of The GP. Aust Fam Physician. Mar;39(3):100-3.
Wedzicha JA, Vestbo J. (2012). Can patients with COPD self-manage? Lancet. Aug 18;380(9842):624-5. doi: 10.1016/S0140-6736(12)61339-7. www.thelancet.com
Willard-Grace R, DeVore D, Chen EH, Hessler D, Bodenheimer T, Thom DH. (2013). The Effectiveness of Medical Assistant Health Coaching for Low-İncome Patients with Uncontrolled Diabetes, Hypertension, and Hyperlipidemia: Protocol for A Randomized Controlled Trial and Baseline Characteristics of The Study Population. BMC Fam Pract.14:27. doi: 10.1186/1471-2296-14-27.
Willgoss TG, Yohannes AM, Goldbart J, Fatoye F. (2012). "Everything was spiraling out of control": experiences of anxiety in people with chronic obstructive pulmonary disease. Heart Lung. Nov-Dec;41(6):562-71. doi: 10.1016/j.hrtlng.2012.07.003.
Yalçın Balçık P, Şahin B. (2013). Sağlık Hizmetlerinde Maliyet Etkililik Analizi ve Karar Analizi. Hacettepe Sağlık İdaresi Dergisi. Cilt: 16 Sayı: 2
Yu AP, Gue´rin A, Leon DP, Ramakrishnan K, Wu EQ, Mocarski M, et al. (2011). Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD. Respiratory Medicine. Dec;105(12):1861-71. doi: 10.1016/j.rmed.2011.07.001
Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J, et al. (2014). Self Management for Patients with Chronic Obstructive Pulmonary Disease. Cochrane Database Syst Rev. Mar 19;3: CD002990. doi: 10.1002/14651858.CD002990.pub3
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