Abstract
BackgroundLong term oxygen therapy (LTOT) has a strong evidence base in COPD patients with respiratory failure, but prescribing practices are recognized to need reform to ensure appropriate use and minimize costs. In the UK, since February 2006, all Home Oxygen prescription is issued by hospitals, making respiratory specialists totally in charge of home oxygen prescription. It has been widely noted that inappropriate home oxygen, often for intermittent use (“short burst”), is frequently prescribed in patients with COPD and related conditions with the intention to prevent hospital admissions outside of evidence based LTOT guidelines. We participated in a national Lung Improvement Project aimed at making LTOT use more evidence based. We utilised this unique opportunity of studying the effect of removal of oxygen from COPD patients (who did not meet LTOT criteria) on hospital admission rates.MethodsPrimary and secondary care data sources were used to identify patients with COPD in a single primary care trust who were admitted to hospital at least once due to COPD between April 2007 and November 2010. Admission rates were compared between LTOT users and non-users, adjusted for age and COPD severity. LTOT users were further studied for predictors of admission in those appropriately or inappropriately given oxygen according to NICE guidance, and for admissions before and after oxygen receipt, adjusting further for co-morbidity. Mortality and economic analyses were also conducted.ResultsReadmission was more likely in LTOT users (3.18 v 1.67 per patient, p < 0.001) after adjustment for FEV1 and age by multiple regression. When stratifying by appropriateness of LTOT prescription, adjusting also for Charlson index and other covariates, FEV1 predicted admission in appropriate users but there were no predictors in inappropriate users. In longitudinal analyses admission rates did not differ either side of oxygen prescription in appropriate or inappropriate LTOT users. Specialist assessment resulted in cost savings due to reduced use of oxygen.ConclusionsAdmission to hospital is more likely in LTOT users, independent of COPD severity. Oxygen use outside NICE guidance does not appear to prevent admissions.
Highlights
Long term oxygen therapy (LTOT) has a strong evidence base in chronic obstructive pulmonary disease (COPD) patients with respiratory failure, but prescribing practices are recognized to need reform to ensure appropriate use and minimize costs
All COPD patients There were 1942 patients identified with COPD, of whom 295 had received oxygen during the study period (Table 1)
A similar relationship was seen to total length of stay, with LTOT patients being much more likely to have an LOS more than 6 days
Summary
Long term oxygen therapy (LTOT) has a strong evidence base in COPD patients with respiratory failure, but prescribing practices are recognized to need reform to ensure appropriate use and minimize costs. We participated in a national Lung Improvement Project aimed at making LTOT use more evidence based We utilised this unique opportunity of studying the effect of removal of oxygen from COPD patients (who did not meet LTOT criteria) on hospital admission rates. Oxygen has a strong evidence base for use in respiratory failure in chronic obstructive pulmonary disease (COPD), following the landmark long term oxygen therapy (LTOT) studies in the 1980s [1,2,3]. COPD admissions are recognized as a large burden to the UK health economy; we felt that a detailed consideration of the effect of rationalizing oxygen use on this was warranted
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