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Community care for COPD: the good, the bad and the ugly
  1. D M G Halpin
  1. Dr D M G Halpin, Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK; D.M.G.Halpin{at}ex.ac.uk

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It is currently fashionable to believe that patients with chronic diseases can be managed safely, effectively and more cheaply, entirely in the community. In the UK, current commissioning and financial models encourage the development of services to provide continuing care as well as to replace acute care traditionally provided by hospitals. For some patients, this may be appropriate, but there is a danger of taking it too far and for patients to be denied appropriate input from specialists.

In the late 1990s, home care services to manage exacerbations of chronic obstructive pulmonary disease (COPD) were introduced in the UK, largely as a way of reducing the strain on the National Health Service’s (NHS) resources caused by the number of patients admitted during the winter months.1 It is now well recognised that some patients with exacerbations of COPD2 3 can be managed safely at home, and in fact this model of care fits into a model of intermediate care for older patients which has been evolving for several decades.4 Intermediate care has been seen as a way of overcoming the loss of independence and disruption of informal and formal patterns of support in the community that can occur on admission to hospital. In some cases, transferring care to the community also has a political dimension and has been seen as a way of reducing the influence of secondary care in determining priorities within local healthcare communities. Although home care or early assisted discharge may minimise the loss of independence that accompanies hospitalisation, patients at home often struggle because they are frail and they may take longer to recover because they miss out on the reablement services available in hospital.

Intermediate care is, however, undoubtedly a suitable way of managing exacerbations for some patients with COPD—but not all. In …

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  • Competing interests: None.

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