Video vs. TTG Respiratory Inhaler Technique Assessment and InstructioN (V-TRaIN)

Asthma and Chronic obstructive pulmonary disease (COPD) results in over a million
hospitalizations in the United States annually and COPD is the third leading cause of 30-day
re-hospitalizations. Clinical trials have established the efficacy of treatments primarily
dispensed via respiratory inhaler devices that reduce morbidity and health care utilization
if they are used correctly. Unfortunately, the effectiveness of these medications in
real-world settings is limited by the fact that patients often do not use inhalers correctly.
Current guidelines recommend assessing and teaching inhaler technique at all health care
encounters, including hospitalization. My work has found that over 75% of hospitalized
patients in an urban, predominantly underserved population misuse their respiratory inhalers,
highlighting a missed opportunity to educate these patients with high potential to benefit.
Hospitalization, therefore, provides a potential 'teachable moment' to correct this misuse.
My preliminary data indicate that one strategy, in-person teach-to-goal (TTG), is effective
in teaching hospitalized patients proper inhaler technique and is more effective than simple
verbal instruction.

While TTG is a promising method to improve care for patients who use inhalers, several
limitations prevent widespread adoption. First, TTG relies on in-person assessment and
education, as well as training and monitoring instructors to ensure fidelity, making it
time-consuming and costly. Also, because a single educational session does not ensure
long-term retention, post-discharge reinforcement may be needed, which may be impractical
with in-person TTG. One potential method to surmount TTG's limitations is use of interactive
video module education (VME), a method that has been used for health education in other
clinical contexts. Through iterative self-assessments and video-demonstrations on a tablet
computer, VME has the potential to be less costly, maintain fidelity, and be more easily
extended into the post-discharge setting than in-person TTG. However, certain questions
remain about VME. It is unclear whether VME will yield similar results when compared to TTG,
or whether patients will have the ability to, and be willing to use, VME in the
post-discharge setting. Therefore, before widespread implementation of VME, it is critical to
rigorously develop and test VME for inhaler education in the hospital setting. Ultimately, it
will also be important to understand patients' ability and willingness to use post-discharge
VME for educational reinforcement to allow for this strategy to transition patients across
care settings from hospital to home.

Inclusion Criteria:

1. Age 18 years and older

2. Admission to the inpatient medical service and surgical service

3. Physician-diagnosed COPD or asthma. We will enroll patients even if the primary reason
for admission is not COPD or asthma (e.g., patients admitted for heart failure, but
with a physician diagnosis of COPD are eligible).

Exclusion Criteria:

1. Currently in an intensive care unit

2. Physician declines to provide consent

3. Patient unable to provide consent (e.g., history of cognitive impairment, unable to
understand English) or declines to provide consent