ARTICLE: Self-medication as Part of Self-management Plans for Patients with COPD - Reply
JOURNAL: JAMA. 2019 May 21;321(19):1937. doi: 10.1001/jama.2019.2076.
We agree with Dr Steurer-Stey that the use of action plans with adequate instructions for self-medication can be helpful for the management of some patients with COPD. However, this approach needs to be individualized and consider patient factors such as comorbidities, cognitive status, and knowledge. As Fan et al1pointed out, self-medication may not be helpful for all patients, and the authors of the recent Cochrane review recommended taking into account comorbidities in self-management action plans.2
As we indicated in our article,3 participants with comorbidities were not excluded. Furthermore, the study intervention was for hospitalized patients with COPD, and these patients are likely sicker and taking more complex medication regimens than participants of self-management trials who are enrolled from outpatient settings. Thus, it was a preferable option to use action plans that did not routinely incorporate self-medication but rather focused on recognition of early signs of an exacerbation and timely connection with clinicians. Realizing that timely access to clinicians may become a concern for some participants, we facilitated access to health care services as part of the multicomponent study intervention.
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