Original articleA Specific Home Care Program Improves the Survival of Patients With Chronic Obstructive Pulmonary Disease Receiving Long Term Oxygen Therapy
Section snippets
Patients
We enrolled 217 consecutive Caucasian COPD outpatients (128 men, age 70±6 years) in the 2-year period from January 1, 1994, until December 31, 1995, on the basis of the inclusion criteria described below. At the time of this study, all the patients were still being cared for (mean time 36.6±10.3mo) by the same respiratory team that performed the study.
For inclusion in the study, patients had: (1) to have a diagnosis of COPD, according to clinical assessment and the results of lung function
Results
All the patients (excluding deaths) completed the follow-up. Neither the daily prescription of oxygen therapy nor compliance to oxygen therapy differed between the HC and SC groups of patients (daily duration 22.2±2h vs 21±3h, respectively; P= NS; compliance to LTOT 90% vs 88% of time prescribed, respectively; P=NS). Likewise, bronchodilator therapy was similar in the 2 groups of patients, as reported in table 2. The number of domiciliary assessments for each year of follow-up were 6.4±3.1,
Discussion
The main finding of our study is that an HC protocol, specifically designed for patients receiving LTOT for chronic respiratory failure related to COPD, is effective in reducing mortality in comparison with conventional care. This increase in survival rate among patients in the HC program seemed to be mainly related to a reduction in exacerbations as well as fewer admissions to the ICU and stabilization of lung function; the need for domiciliary mechanical ventilation appeared to be lower among
Conclusions
The increasing burden of chronic conditions such as COPD, chronic heart failure, or diabetes mellitus has been accompanied by the development of chronic disease management programs that provide continuity of care such that patients' outcomes are improved and unnecessary re-admissions to hospital are avoided. Recently, Pearson et al22 found that a non-specific HC program provided long-term benefits for patients with a range of chronic diseases, but not for those with COPD suggesting that
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