Self-administration of medical modalities (SAMM): another method of rehabilitation education.

In order to train patients to carry out home pulmonary care adequately, we developed a hospital-based patient-education program we call Self-Administration of Medical Modalities (SAMM). This teaches patients about their pulmonary disease; about their medications' purposes, side effects and what to do if they occur, possible conflict with other medications, and the medication schedule; about use, care, and cleaning of aerosol inhalation devices and scheduling of aerosol medication treatments; and about chest physical therapy if it is indicated. Nurses, respiratory therapists, and physical therapists in the hospital teach and reinforce these concepts and evaluate the patient's progress in learning. The patient advances through three levels of competency. At Level I he is responsible only for keeping track of his medication and treatment schedules. At Level II the patient initiates requests for medication and treatments on schedule, takes them under supervision, and makes a written record of having done so. At Level III the patient's medications are kept at his bedside, he prepares and takes the medications himself, takes treatments himself, and he keeps written records. At this level the program simulates home conditions as much as possible. Patients have reported that they liked administering their own medications and treatments and that the SAMM Program was helpful in preparing them for self-care at home.

Clinical and physiological outcomes of a university-hospital pulmonary rehabilitation program.

Pulmonary rehabilitation programs have resulted in improvements in quality of life, capacity for carrying out daily activities, and physical conditioning, as well as reduced hospitalization and cost of care. In our retrospective study, we reviewed the data of 75 patients who had participated in Loma Linda University Medical Center's pulmonary rehabilitation program--in order to determine its effect on survival, progression of disease, and quality of life for a selected group of patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary rehabilitation team evaluated each patient and developed for him a plan of care that included a 2-week inpatient education program. The cumulative survival rate of our group computed by the life table methods was 86.5% at 5 years of rehabilitation, and 64% at 10 years. The mean FEV1 at the beginning of the program was 1.53 1 and the mean FVC was 2.87 1; the mean change in FEV1 was - 45 ml/yr, and in FVC, - 70 ml/yr. By use of a questionnaire, we also found that most of our responding patients felt that their quality of life had improved. Our findings compare favorably with other published data and suggest that it is possible to improve the survival of patients with COPD by early diagnosis, comprehensive treatment, continuing medical care, and home visitation.