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COPD exacerbations

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J. R. Hurst, F. Fitzgerald-Khan, J. J. P. Goldring, J. K. Quint, J. P. Dilworth, C. Mikelsons, J. A. Wedzicha. Royal Free Hampstead NHS Trust, London, UK

Introduction The “epidemic” of chronic obstructive pulmonary disease (COPD) requires innovative service developments to improve outcomes. It is particularly important to prevent hospitalisations. Successful chronic care models in COPD have been described. We present the first evaluation of an Early Presentation and Intervention in COPD (EPIC) service focused on “informed” 24/7 telephone support for high-risk NHS COPD patients. The service was funded by a Clinical Innovations competition at Royal Free Hampstead NHS Trust.

Method 74 “high-risk” patients were recruited over 6 months (defined as GOLD stage IV or those with previous hospitalisation) from inpatient and outpatient settings, representing 32% of patients admitted over that period. After a recruitment interview to record key patient and COPD information, patients were contacted every 2 months by a nurse and reviewed in clinic 6-monthly. Patients were invited to use the telephone service “when you need any advice about your chest and particularly if you think you are having a flare-up”. We present the use and utility of the service over 1 year.

Results The 74 patients were high-risk (eg, mean (SD) age 70.3 (9.1) years, forced expiratory volume in 1 s 44.2 (16.5)%). 30% were on long-term oxygen therapy and 46% lived alone. 70% of patients completed 1 year, 23% died and 7% left. Follow-up was for a total of 22074 days. 76% of patients used the service or it was used on their behalf, generating 258 calls (mean duration 7.9 min) at a rate of 1 call/100 patients/day. 76% of calls were between 08.00 h and 17.00 h. The proportion of calls in response to possible exacerbation did not vary by day, but was higher overnight …

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