RT Journal Article
SR Electronic
T1 Education Experiences of Adult Subjects and Caregivers for Mechanical Insufflation-Exsufflation at Home
JF Respiratory Care
FD American Association for Respiratory Care
SP 1889
OP 1896
DO 10.4187/respcare.07534
VO 65
IS 12
A1 Craig M Dale
A1 Doug McKim
A1 Reshma Amin
A1 Sarah Carbone
A1 Tom Fisher
A1 Roger Goldstein
A1 Sherri Katz
A1 Andrea Gershon
A1 David Leasa
A1 Mika Nonoyama
A1 Regina Pizutti
A1 Anu Tandon
A1 Louise Rose
YR 2020
UL http://rc.rcjournal.com/content/65/12/1889.abstract
AB BACKGROUND: In 2014, the Ministry of Health of Ontario, Canada, approved a program of public funding for specialist-prescribed mechanical insufflation-exsufflation (MI-E) devices for home use by individuals with neuromuscular respiratory insufficiency. Since 2014, 1,926 MI-E devices have been provided, exceeding device-use projections. Few studies describe the initial and ongoing education and support needs of home MI-E users and their family caregivers. This study aimed to explore the requirements of initial and ongoing education and support for MI-E device use, user confidence, and barriers and facilitators to home MI-E.METHODS: We conducted semi-structured interviews with new (< 6 months) and established (6–48 months) MI-E users and family caregivers. Device users rated their confidence on a numeric rating scale of 1 (not confident) to 10 (very confident).RESULTS: We recruited 14 new and 14 established MI-E users and caregivers (including 9 dyads), and we conducted 28 interviews. Both new and established users were highly confident in use of MI-E (mean ± SD scores were 8.8 ± 1.2 and 8.3 ± 2.1, respectively). Overall, the subjects were satisfied with their initial education, which consisted of a 1–2 h one-on-one session at home or in the clinic with a device demonstration and hands-on practice. Subjects viewed hands-on practice and teaching of caregivers as more beneficial than written materials. Ongoing support for device use was variable. Most subjects indicated a lack of specific follow-up, which resulted in uncertainty about whether they were using the MI-E device correctly or whether MI-E was effective. Facilitators to device utilization were ease of use, initial training, support from formal or informal caregivers, and symptom relief. Barriers were inadequate education on MI-E purpose, technique, and benefit; lack of follow-up; and inadequate knowledge of MI-E by nonspecialist health providers.CONCLUSIONS: The current model of home MI-E education at initiation meets user and caregiver needs. Better ongoing education and follow-up are needed to sustain the benefits through assessment of MI-E technique and its effectiveness.