Introduction and Objectives Home Oxygen in England costs around £110 million yet it is estimated that 30% of patients derive no clinical benefit (DH, 2010).1 In addition oxygen can be harmful if used inappropriately. The RD&E Home Oxygen Service was set up in 2008 to provide a comprehensive oxygen assessment service for all adult patients requiring Long Term Oxygen Therapy (LTOT) including the provision of follow-up in the patient's home. 1044 patients have been seen by this service so far, and 63 concentrators removed following assessment by the home oxygen team.
Methods We evaluated retrospectively the patients who had oxygen removed. The characteristics of this population were investigated including reason for removal, whether an oxygen assessment had been undertaken and the appropriateness of oxygen prescription.
Results On assessment 85% (54/63) had saturations >92% and 49% (31/63) were not using their oxygen. Of the 63 patients who had their oxygen removed more patients (53%) had their LTOT initiated in Primary Care. These patients therefore received no formal assessment prior to initiation. When assessed 67% did not meet the criteria for LTOT. Of the 63 those established on LTOT by the Home Oxygen Service, it was primarily in the context of an inpatient stay. In these cases adequate follow-up and review allowed oxygen to be removed once stable. The economic saving from the removal of inappropriate oxygen is considerable. 60% (38/60) no longer required oxygen therapy amounting to a cost saving of £20 330. 39% were re-categorised to a lower tariff but 17% proved difficult to wean and continued on Short Burst Oxygen (SBOT) despite inadequate evidence for this therapy.
Conclusion Our experience suggests as integrated oxygen service allows a more robust approach to oxygen prescription and monitoring. It reduces the risk of harm from oxygen prescription, and unnecessary prescriptions. This has both financial and medical benefits. Direct prescription of LTOT from primary care by comparison carries a risk of inadequate initial assessment and follow-up.
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