Nationwide implementation of the self-management program "Living well with COPD": Process and effectiveness evaluation using a mixed-methods approach.

OBJECTIVE: To evaluate the nationwide implementation of the "Living well with COPD" program by the Swiss Lung Association in various cantons in Switzerland. METHODS: For the process evaluation, we used qualitative (interview, focus group) and quantitative (questionnaires, documentation analysis) methods to assess the implementation outcomes reach, dose, fidelity and acceptability. For the effectiveness, we performed a pre-post analysis of patient data collected at baseline and program end (after 14 months). RESULTS: Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients. Patients' attendance rate was 81% and coaches' fidelity to protocol 94%. Acceptance and satisfaction of all involved persons was high. Integration of the coaches' additional workload, uncertainties regarding roles and responsibilities and sustainable reimbursement were major challenges. Patients significantly improved in COPD specific quality of life and increased exercise capacity with on average 3.2 more repetitions in the 1-minute sit-to-stand test. CONCLUSION: The program was successfully implemented throughout Switzerland with high acceptability and positive association with patients' quality of life. PRACTICE IMPLICATIONS: Our findings support the broader multiplication throughout Switzerland and serves the international community since it is one of the first nationwide implementations beyond study settings.

Risk of Sleepiness-Related Accidents in Switzerland: Results of an Online Sleep Apnea Risk Questionnaire and Awareness Campaigns.

OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is associated with major morbidity and mortality but OSAS is frequently under recognized. To promote awareness of OSAS, the Swiss Lung League launched an online questionnaire combined with annual advertisements in mass media. Characteristics of participants, prevalence of sleep apnea, OSAS-related symptoms, and their association with accidents were investigated. METHODS: A questionnaire was created incorporating anthropometrics, the Epworth sleepiness scale (ESS), the OSAS domain of the sleep disorders questionnaire (SDQ), and a question on accidents related to sleepiness. RESULTS: A total of 198,422 persons participated, 63% were male, mean (±SD) age was 45 (±16) years, weight 80 (±18) kg, height 173 (±9) cm, and body mass index 26.7 (±5.4) kg/m2. Some male (19%) and female (17%) participants had both elevated ESS and SAS scores (SAS > 35 (m)/SAS > 31 (f) and ESS > 10) and were suspected of having sleep apnea. In all, 6,654 (3.4%) had suffered an accident related to sleepiness. In multivariate regression analysis, ESS item #8 (falling asleep on the wheel, while stopping for a few minutes in traffic) was closest related to suffering an accident (OR 2.8). CONCLUSION: The OSAS awareness campaign of the Swiss Lung League reached a large number of people of both genders and of a wide age range. Many participants suffered from excessive sleepiness and symptoms of sleep apnea were highly prevalent. The campaign raised awareness of OSAS and contributed to the diagnosis and treatment of sleep apnea, thereby possibly preventing related morbidity and mortality.