Eligibility testing for long-term domiciliary oxygen therapy: more often, more effective?

Abstract

Long-term oxygen therapy (LTOT) is used in patients with chronic hypoxemia in order to delay disease progression and increase survival. Current guidelines provide the criteria for LTOT prescription, outlining the requirements for both chronic hypoxemia and clinical stability documentation. However, in clinical practice, the physiological criterion prevails and, therefore, unstable patients that are considered eligible for LTOT are found to be ineligible at the next eligibility assessments. Moreover, many LTOT providers request eligibility recertification 1 year after initial prescription. In this way, many ineligible patients receive LTOT inappropriately until the reassessment and significant financial resources are wasted. Guidelines for LTOT prescription currently recommend an intermediate eligibility reassessment 2 months after the first LTOT prescription and the existing data support this approach. The current randomized study evaluates the effectiveness of an alternative eligibility testing approach with scheduled intermediate assessments, versus a conventional approach without, in terms of detection of eligible patients, oxygen cost savings and health resource utilization.