Appropriateness of Domiciliary Oxygen Delivery

doi:10.1378/chest.118.5.1303

Chest

Volume 118, Issue 5, November 2000, Pages 1303-1308

https://doi.org/10.1378/chest.118.5.1303 Get rights and content

Objective

Almost every country in the developed worldhas a domiciliary oxygen program. Whether recipients meet programcriteria has not been rigorously studied.

Design

Cross-sectional survey.

Participants

Two hundredthirty-seven patients receiving domiciliary oxygen in the OntarioMinistry of Health Home Oxygen Program (HOP).

Methods

A respiratory therapist visited the patients' homes and administeredquestionnaires, obtained resting arterial blood gas measurements, andconducted a standardized home exercise test while monitoring oxygensaturation using an oximeter.

Measures of outcome

Weevaluated the extent to which patients met HOP criteria that are basedon the inclusion criteria of randomized trials showing thelife-prolonging effects of domiciliary oxygen. We also assessed theextent to which the patients' oxygen prescription was consistent withthe results of rest and exercise testing.

Results

Ninety-six of 237 participants (40.5%; 95% confidence interval, 34.3to 46.8) did not meet criteria for home oxygen. Patients aged ≤ 70years were more likely to meet criteria (71 of 105 patients; 67.9%)than those > 70 years old (70 of 132 patients; 53.0%). Theproportion of patients meeting criteria was similar whether thereferring physician was a specialist (71 of 112 patients; 62.5%) or aprimary-care physician (69 of 123 patients; 56.1%). A very importanthealth benefit from oxygen was identified among 82% of those who metcriteria and 88% of those who did not. Patients received higher flowrates than our criteria suggested were appropriate. Agreement betweenthe independently assessed oxygen prescription at rest and thepatients' report of oxygen use was extremely poor (chance-correctedagreement [κ], 0.17), as was agreement concerning optimal exerciseflow rates (κ, 0.26).

Conclusions

Currentprocedures for administration and reimbursement of home oxygen resultin a large proportion of recipients not meeting criteria, as well asthe prescription of excessive oxygen flow rates. These results arelikely to apply to many jurisdictions and suggest a large potential formore efficient resource allocation.

Section snippets

Recruiting Patients

We identified all patients living in central Toronto, a city of2.5 million people, or in the vicinity of Ottawa (metropolitanpopulation, 1 million) receiving home oxygen funded by the HOP, who hada first-time oxygen application signed by a physician between July 1,1995, and January 31, 1997. We excluded patients < 18 years old andthose receiving oxygen for palliative care. We contacted the physiciansof eligible patients; if the physicians approved of their patients'participation, we contacted

Recruitment and Patient Characteristics

From a list of 557 potential participants, we found that 42 haddied, 87 were no longer receiving oxygen, and 10 had moved out of thearea. Of the remaining 418 patients, another 181 did not participate.The reasons included patients being too ill (n = 86), language orsocial barriers (n = 34), physician or patient refusal (n = 51),and our inability to contact the patient (n = 2). Another eightpatients were consistently unstable throughout the study.

Table 1presents a comparison of the 237 patients

Discussion

The strengths of this study include the comprehensive survey ofcurrent oxygen recipients in a defined geographic area, the aggressiveefforts to recruit all potentially eligible patients, and therigorously standardized methodology of the measurement of resting andexercise oxygenation. A further strength was our ensuring that patientswere receiving optimal medications and were clinically stable at thetime of our assessment, as well as the attention to the reproducibilityof our ratings. We have

ACKNOWLEDGMENT

We would like to thank Michel Bedard forstatistical analysis, Mika Nonoyama and Laurie Taylor for technicalsupport in data collection, and Lisa Buckingham, Suzanne Duchesne,Deborah Maddock, and Karen Burns for support in data management, dataentry, and study organization. We are indebted to Monica Reilly andCarol Jones of the Ontario Ministry of Health HOP for their support.

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Pesquisa bibliográfica na base de dados MEDLINE/PubMed (1990 a 2011). Adicionalmente, referências de estudos selecionados foram incluídas. Como para muitos dos aspectos não existem evidências científicas consistentes, algumas recomendações citadas foram feitas com base em experiência clínica.
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Chest

Clinical InvestigationsCOPDAppropriateness of Domiciliary Oxygen Delivery

Objective

Design

Participants

Methods

Measures of outcome

Results

Conclusions

Section snippets

Recruiting Patients

Recruitment and Patient Characteristics

Discussion

ACKNOWLEDGMENT

Chest

Chest

Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema: report of the Medical Research Council Working Party

Lancet

Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease

Ann Intern Med

A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstruction pulmonary disease and daytime PaO2above 60 mm Hg

Am Rev Respir Dis

Measuring nominal scale among many raters

Psychol Bull

Clinical Investigations
COPD
Appropriateness of Domiciliary Oxygen Delivery

A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstruction pulmonary disease and daytime PaO₂above 60 mm Hg