A handful of studies have pointed to explanations related to a patient’s reluctance to wear a cannula or breathe oxygen for 15 hours a day. Fewer studies have determined strategies aimed at improving LTOT (Long Term Oxygen Therapy) use. Adherence is not generalizable and may differ with treatment or by condition. Adherence is a dimensional construct and no current explanatory theory or model specific to LTOT exists. LTOT adherence varies between 45-70% therefore an explanatory model is needed which addresses patient and treatment factors.
An Oxygen Adherence Model was developed which defined the variables, processes and barriers present when LTOT and a respiratory disability interact. This hierarchical and tiered model is related to established drug adherence constructs, respiratory health behavior theory, and physiologic variables inherent with chronic respiratory disease.
Adherence will advance as the variables and domains in each tier are addressed. Tier 1, Chronic Respiratory Disability is defined by symptoms and physiologic deteriorization which is assisted via LTOT. Tier 2, Information Enhancement, is educational as the clinician assists the patient and family with understanding LTOT. Interventions and treatments related to Tier 3, Emotional and Psychological Limitations, should be focused to improving self-efficacy. Tier 4, Reduction of Treatment Barriers should be approached with the goal of therapeutic effectiveness.
Health behavioral and psychological models explain general adherence behavior and have been effective in guiding interventional strategies for many conditions and health promotion. The Oxygen Adherence Model can be tested to determine approaches appropriate to limiting symptoms, improving physical limitations, educating the patient, addressing psychological and emotional variables as well as reducing barriers to more effective oxygen therapy.
Chronic disease management includes adherence plans. Most patients find LTOT a complex treatment. New strategies and research related to LTOT adherence may assist with improved LTOT utilization by patients.
Tier 1Tier 2Tier 3Tier 4Chronic Respiratory DisabilityInformation EnhancementEmotional and Psychological LimitationsTreatment BarriersSymptoms: Dyspnea, Fatigue, Anxiety, Depressed Mood PhysiologicDeteriorization: Arterial Oxygen Desaturation Exercise capacity Body Mass Index Cognitive status Functional statusPrescription Knowledge Treatment rationale Technical ability Motivational enhancementDenial Hopelessness Apathy Misery Isolation Burden Stigma Fear of addiction Fear of dependence Depressed mood Anger Health belief conflictsPoor provider support Limited clinician communication Not practically portable Expensive Inconvenient Duration of treatment Complexity Life style interference
Deborah Cullen, None.