Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy.

Abstract:

STUDY OBJECTIVES:To analyze the influence of a hospital-based home-care program (HCP) on the management of patients with COPD receiving long-term oxygen therapy. DESIGN AND SETTING:Randomized, controlled study in a 1,000-bed university hospital. INTERVENTION:The HCP applied to patients in the intervention group (HCP group) consisted of a monthly telephone call, home visits every 3 months, and home or hospital visits on a demand basis. Patients in the control group were given conventional medical care. MEASUREMENTS:Pulmonary function data, gas exchange, use of hospital resources (emergency department visits, admissions, and hospital stay) and the cost of medical assistance were investigated in both groups before and after 1 year of study. Quality of life was analyzed using the chronic respiratory questionnaire in the first 40 consecutive patients included in the study. Survival throughout the study was also assessed. RESULTS:One hundred twenty-two patients were enrolled in the study, and 94 patients (46 in the HCP group and 48 in the control group) completed the 1-year follow-up period: 83 patients (88%) were men, and mean (+/- SD) age was 68 +/- 8 years. During the follow-up period, there was a highly significant decrease in the mean number of emergency department visits (0.45 +/- 0.83 vs 1.58 +/- 1.96; p = 0.0001) and also a significant decrease in hospital admissions (0.5 +/- 0.86 vs 1.29 +/- 1.7; p = 0.001) and days of hospital stay (7.43 +/- 15.6 vs 18.2 +/- 24.5; p = 0.01) in the HCP group. Patients in the intervention group required a total of 221 home visits (mean per patient, 4.8 +/- 0.8) and 69 hospital visits (mean per patient, 1.5 +/- 1.07). In spite of the cost of the program, cost analysis showed a total saving of 8.1 million pesetas ($46,823) in the HCP group, mainly due to a decrease in the use of hospital resources. There was no difference in pulmonary function, gas exchange, quality of life, and survival between the two groups. CONCLUSIONS:Hospital-based home care is an effective alternative to hospital admission. It reduces the use of hospital resources and the cost of health care.

journal_name

Chest

journal_title

Chest

authors

Farrero E,Escarrabill J,Prats E,Maderal M,Manresa F

doi

10.1378/chest.119.2.364

subject

Has Abstract

pub_date

2001-02-01 00:00:00

pages

364-9

issue

2

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)38209-X

journal_volume

119

pub_type

临床试验,杂志文章,随机对照试验

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