Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial

Marilyn L Moy; Kathleen F Harrington; Alice L Sternberg; Jerry A Krishnan; Richard K Albert; David H Au; Richard Casaburi; Gerard J Criner; Philip Diaz; Richard E Kanner; Ralph J Panos; Thomas Stibolt; James K Stoller; James Tonascia; Roger D Yusen; Ai-Yui M Tan; Anne L Fuhlbrigge; LOTT Research Group

doi:10.1016/j.rmed.2019.02.004

Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial

Respir Med. 2019 Mar:149:52-58. doi: 10.1016/j.rmed.2019.02.004. Epub 2019 Feb 13.

Authors

Marilyn L Moy¹, Kathleen F Harrington², Alice L Sternberg³, Jerry A Krishnan⁴, Richard K Albert⁵, David H Au⁶, Richard Casaburi⁷, Gerard J Criner⁸, Philip Diaz⁹, Richard E Kanner¹⁰, Ralph J Panos¹¹, Thomas Stibolt¹², James K Stoller¹³, James Tonascia¹⁴, Roger D Yusen¹⁵, Ai-Yui M Tan¹⁶, Anne L Fuhlbrigge⁵; LOTT Research Group

Affiliations

¹ Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA. Electronic address: marilyn.moy@va.gov.
² Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁴ University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁵ University of Colorado School of Medicine, Aurora, CO, USA.
⁶ Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA, USA.
⁷ Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
⁸ Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
⁹ Pulmonary, Allergy, Critical Care, and Sleep Medicine Division, Ohio State University, Columbus, OH, USA.
¹⁰ Division of Pulmonary Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
¹¹ Cincinnati Veterans Affairs Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹² Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹³ Cleveland Clinic, Cleveland, OH, USA.
¹⁴ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁵ Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA.
¹⁶ Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.

Abstract

Rationale: Characteristics associated with adherence to long-term oxygen therapy (LTOT) in COPD remain unclear.

Objectives: To identify patient characteristics at the time of oxygen initiation associated with its adherence.

Methods: We conducted a secondary analysis of data from 359 COPD participants assigned to oxygen in the Long-term Oxygen Treatment Trial. Participants were prescribed continuous (n = 214) or intermittent (n = 145) oxygen based on desaturation patterns at study entry. At the time of initial prescription, participants rated their perceived readiness, confidence, and importance to use oxygen on a 0-10 scale (0 = not at all, 10 = very much). During follow-up, they self-reported average hours per day of use (adherence). Adherence was averaged over short-term (0-30 days), medium-term (months 9-12), and long-term (month 13 to last follow-up) intervals. Multivariable logistic regression models explored characteristics associated with high adherence (≥16 h/day [continuous] or ≥8 h/day [intermittent]) during each time interval.

Results: Participant readiness, confidence, and importance at the time of oxygen initiation were associated with high short- and medium-term adherence. For each unit increase in baseline readiness, the odds of high short-term adherence increased by 21% (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.05-1.40) and 94% (OR 1.94, 95% CI 1.45-2.59) in the continuous and intermittent groups, respectively. In both groups, high adherence in the medium-term was associated with high adherence in the long-term (continuous, OR 12.49, 95% CI 4.90-31.79; intermittent, OR 38.08, 95% CI 6.96-208.20).

Conclusions: Readiness, confidence, and importance to use LTOT at initiation, and early high adherence, are significantly associated with long-term oxygen adherence.

Trial registration: ClinicalTrials.gov NCT00692198.

Keywords: Adherence; COPD; Confidence; LTOT; Readiness; Self-efficacy.

Publication types

Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Aftercare
Aged
Disease Progression
Early Intervention, Educational / methods
Female
Humans
Hypoxia / therapy
Male
Middle Aged
Outcome Assessment, Health Care
Oxygen Inhalation Therapy / psychology*
Oxygen Inhalation Therapy / statistics & numerical data
Oxygen Inhalation Therapy / trends*
Perception / physiology
Pulmonary Disease, Chronic Obstructive / epidemiology
Pulmonary Disease, Chronic Obstructive / physiopathology
Pulmonary Disease, Chronic Obstructive / therapy*
Self Concept
Self Efficacy
Time
Treatment Adherence and Compliance / psychology*
Treatment Adherence and Compliance / statistics & numerical data

Associated data

ClinicalTrials.gov/NCT00692198

Grants and funding

N01HR76197/HL/NHLBI NIH HHS/United States