lts, the necessary coping strategies were given to the patients. In the process, Patients gain a sense of control and security over their illness. Bond  also found similar results, some patients believed that they are involved in medical decisions, but some patients thought the use of the remote device to be a burden for them. This is understandable, because it can be difficult for COPD patients to detect and respond appropriately to worsening conditions. And that the details were worked out by the nurse and patient is still in a passive position, the hoped-for “participatory health” into a “medical paternalism”. Relevant studies  also prove this point, the researcher thought most of the current studies described relationship of empowerment between doctors and patients as “authorization” and “obedience”, ignoring the patient’s subject status in the process of empowering. Lilholt, Haesum, and Hejlesen  have also proved that telemedicine can improve ability of disease management, but the difference is that It’s a pure quantitative study. In China, relevant studies conducted by Luan  and Li  have also confirmed that telemedicine has great benefits in self-management and self-efficacy of COPD patients.
The effects of telemedicine devices are considerable. A common feature of these studies is that as patients spend more time using telemedicine devices, their disease management ability, quality of life and emotional improvement also increase. Rixon et al.  also demonstrated the viewpoint.
4.6. Website Communication
The development of the Internet has provided a new platform for empowerment. Through online conversations with 398 COPD patients, Wentzer and Bygholm  concluded that online support group was an important resource for empowerment, and developed corresponding coping strategies based on the most talked about topics (smoking cessation and rehabilitation courses).Lu and Zheng  developed a network platform for patient of COPD, although the purpose was to confirm whether the relevant volunteers were COPD patients, patients actively participated in this process during the collection of disease information and improved their disease management ability.
5. Factors Influencing the Empowerment of Patients with COPD
Although a lot of researches shown that empowerment can improve patientsability of disease management, not all patients respond to empowerment in this process  . In other words, the level of receive empowerment depends on their participation about health issues  . If only empowering rights of patients without evaluation, it may lead to the aggravation of the patient’s illness and even death  . Therefore, “patient activation” is also the focus of many researchers, most of whom measure the activation degree and ability of patients after empowerment through the PAM-13 scale.
Studies indicated that relevant factors mainly include psychological factors (such as not wanting to face the occurrence or aggravation of the disease), no experience in coping with the disease, and lack of external support, but external support is also proposed as a contributing factor    . Mullerova et al.  concluded that high expectations of disease, poor health, and low satisfaction with health care workers are also barriers. Stoilkova-Hartmann, Franssen, Augustin, Wouters, and Barnard  further refined the obstacles in the process of disease management, such as social support, environment and lifestyle in external factors, health belief and internal motivation in internal factors [Table 2]. The results of these studies suggest that the quality of life and self-management of disease in patients with COPD are dependent on the individual’s condition after empowerment.
From the above, empowerment theory is a process in which patients gain the ability to cope with diseases and improve their sense of self-efficacy and have necessary knowledge, skills and attitudes. In addition, the empowerment process emphasizes patient involvement. More and more attention has been paid to the application of empowerment theory in patients with COPD. In view of the current situation, the following outlook is proposed:
At present, the measurement tools for chronic diseases are diversified, and it’s applied to different specialist areas. Since most of them are introduced from foreign countries, we need to verify whether they are practical in application. PAM-13
Table 2. Influencing factors of COPD patient empowerment.
is widely used in foreign countries for COPD empowerment measurement tools, but it has not been sinicized at present, which is a direction of future research. In addition, in the process of using and developing the scale, the influencing factors of empowerment should be fully considered. A large number of studies are still needed to explore which factors can be corrected, and then improve patients’ ability to accept empowerment and enjoy a higher quality of life. In the study, we should pay attention to the heterogeneity of patient characteristics and formulate different intervention measures according to different characteristics.
Empowerment has a significant effect on the etiology prevention, exercise, breathing exercise, telemedicine and website communication about COPD patients. Considering the complexity, repetition, and progressiveness of COPD, empowerment had little effect on readmission rates, only shortened the readmission time. We need more comprehensive disease management programme to improve outcomes in the future. In order to adapt to the economic restructuring, chronic disease management is particularly important. But due to the heterogeneity of COPD, we must take into account the impact of a patient’s unique environment when caring for them. COPD patients still need regular outpatient follow-up in the stable stage of the disease, so as to detect the progress of the disease, but it also causes increased pressure on outpatient visits. As a new empowerment tool, telemedicine reduces the pressure on the number of patients in medical departments and optimizes the health resources, which is the trend of smart medical research and direction of future research. Besides, monitoring the use of telemedicine is extremely important, because we don’t just keep track of the data, we need to make professional judgments about the progress of the disease. The expertise of professionals is the lifeblood of remote device use, which cannot be ignored in future studies.
This study was supported by Hubei Natural Science Fund Project (2017CFB786).
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