Chronic Obstructive Pulmonary Disease

Abstract

Introduction: COPD has significant morbidity and incurs heavy utilization ofhealthcare resources.Objectives: To assess whether a comprehensive care programme candecrease hospital admissions and length of hospital stay (LOS) for COPDpatients.Methods: In a randomized control trial of patients discharged from hospitalafter an episode of acute exacerbation of COPD, patients were randomized toan Intervention Group (IG) or Usual Care Group (UG). The IG received acomprehensive, individualized care plan which included respiratory nurse edu-cation, physiotherapist support for pulmonary rehabilitation, 3-monthly tele-phone calls by a respiratory nurse for a period of 1 year, and followed up inrespiratory clinic by a respiratory specialist once every 3 months for 1 year. TheUG were managed according to standard practice. All patients had assess-ments (spirometry, 6 minute walk test, dyspnoea score [Modified MedicalResearch Council Dyspnoea Scale {MMRC}], and quality of life [QOL] [St.Georges Respiratory Questionnaire {SGRQ}]) at baseline and at 12 months.The primary outcome was 12-month hospital readmission.Results: 180 patients were recruited (IG N = 90,UG N = 90; mean age74.7 ± 8.2yrs, 172(95.6%) males; mean FEV1 45.4 ± 16.6% predicted). At 12months, the IG had fewer readmissions (1.56 ± 2.13 vs 2.38 ± 2.14times,p = 0.0008) and shorter LOS (7.41 ± 11.29 vs 12.21 ± 12.87days, p = 0.0003)for COPD than UG. IG at 12 months had improved mean MMRC (-0.1 ± 0.7 vs0.2 ± 0.6, p = 0.033) and SGRQ score (-8.5 ± 16.6 vs −0.1 ± 15.7, p = 0.002)compared with UG.Conclusion: Comprehensive COPD programme can reduce hospital read-missions for COPD and LOS, and improve symptoms and QOL of the patients.