CHRONIC OBSTRUCTIVE PULMONARY DISEASE

A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease

M Sridhar^*, R Taylor, S Dawson, N J Roberts, M R Partridge

NHLI Division, Faculty of Medicine, Imperial College London, Charing Cross Campus, London, UK

Professor M R Partridge, NHLI Division, Faculty of Medicine, Imperial College London, Charing Cross Campus, London W6 8RP, UK; m.partridge{at}imperial.ac.uk

Objectives: To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Design: Randomised controlled trial.

Setting: Community and hospital care in west London.

Participants: 122 patients with COPD.

Intervention: A care package incorporating initial pulmonary rehabilitation and self-management education, provision of a written, personalised COPD action plan, monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years.

Main outcome measure: Hospital readmission rate.

Secondary outcomes: Unscheduled primary care consultations and quality of life.

Results: There were no differences in hospital admission rates or in exacerbation rates between the two groups. Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics, and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves. 12 patients in the control group died during the 2 year period, eight as a result of COPD, compared with six patients in the intervention group, of whom one died from COPD. This is a significant difference. When the numbers were adjusted to reflect the numbers still alive at 2 years, in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner (GP) and in the control group, 280 contacts. The number needed to treat was 0.558—ie, for every one COPD patient receiving the intervention and self-management advice, there were 1.79 fewer unscheduled contacts with the GP.

Conclusions: An intermediate care package incorporating pulmonary rehabilitation, self-management education and the receipt of a written COPD action plan, together with regular nurse contact, is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate.

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