Role of the Management Pathway in the Care of Advanced COPD Patients in Their Own Homes

Abstract

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, and the incidence and prevalence are rising every decade. The cost of hospital admission is substantial and is the single largest source of expenditure in care of COPD patients. Home-based intervention has been shown to provide long-term cost benefit in a range of chronic illnesses; however, the role of home visits by respiratory therapists (RT) in COPD management has not been evaluated. The aim of this study was to assess the efectiveness of a management pathway in the care of oxygen-dependent COPD patients in their homes. Oxygen-dependent COPD patients were enrolled in the management pathway after discharge from the hospital or referred from a provider's office. At least three home visits were made: the first within 3 days of enrollment; the second in 1 month, and the third 10 months later. Three hundred and twenty-four patients were enrolled in the study. During the study period the overall hospitalization rate dropped (11% per month at the second visit vs. 2.1% per month at the third visit). The patients' understanding of the disease improved substantially (21.6% vs. 83.9%), knowledge of medications the patients were taking improved (56.0% vs. 87.0%), and appropriate use of medications increased (52.0% vs. 86.0%). In our community, this RT-led program helped patients' self-management of COPD in their own homes by increasing understanding of the disease, assisted physicians in monitoring their patients, and reduced hospitalization.