Care For COPD Patients Research Articles

Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.

ObjectivesTo examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs) and primary care physicians.MethodsWe conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER) visit, number of hospitalizations and 30-day readmission in 2010.ResultsA total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05–1.32), oxygen therapy (aOR = 1.25, 95% CI 1.12–1.40) and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23–1.56), but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71–0.98) and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07–1.48) than those cared for by physicians.ConclusionsCompared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and APPs.

Home mechanical ventilation patients: a retrospective survey to identify level of burden in real life

Home care for patients under home mechanical ventilation (HMV) may cause dramatic physical and economic burden in addition to the burden of time on family/caregivers and health care service (HCS) with difficult resource allocation decision-making. Our aims were: 1. To identify conditions causing major care burden in managing HMV patients according to family and payer's perspectives related to characteristics of the disease, dependency and accessibility; and 2. To find, if any, differences among diseases. A questionnaire was sent to eight pulmonary centres to identify factors connected with the greater care burden. Retrospective data of 792 patients still alive and in HMV was reviewed. Compared to neuromuscular disorders (NM) and chest wall deformities, the COPD group have presented a statistically greater number of hospitalisations/yr (1.37 +/- 0.77), greater length of stay (13 +/- 10 days), higher number of outpatient visits/yr (2.55 +/- 1.73) or emergency room accesses/yr (0.74 +/- 1.08). Patients with NM diseases need more home care. The prevalence of one, two and three among five selected burden criteria (needs of MV > 12 hrs/day, tracheotomy, high dependency, distance from hospital, frequent hospitalisations) was respectively 19%, 30% and 33% of the cases; the NM was the group most represented. In HMV patients: 1. underlying disease, level of their dependency, hours spent under MV, presence of tracheotomy, home distance from hospital, hospital accesses are the causes of major care burden; and 2. as a novelty we have demonstrated that more than fifty percent of them present two or three contemporaneous criteria selected as care burden, being NM and COPD patients the most representative group necessitating of family's and HCS's care respectively.

The changing nature of chronic care and coproduction of care between primary care professionals and patients with COPD and their informal caregivers.

The aim of this study was to investigate whether care delivery in accordance with a care model is associated with co-productive relationships between professionals and COPD patients and their informal caregivers. A co-productive relationship refers to productive patient–professional interaction or shared decision making. This cross-sectional study was conducted in 2014 among 411 patients (out of 981) enrolled in the Dutch COPD care program Kennemer Lucht and 62 professionals treating them (out of 97). Kennemer Lucht COPD involved multicomponent interventions within all six dimensions of the chronic care model (organizational support, community, self-management, decision support, delivery system design, and information and communications technology) to improve the quality of care for patients with COPD. This approach was expected to improve relational coproduction of care between professionals and patients with COPD and their informal caregivers. Results show clearly that the perceived quality of chronic care delivery is related significantly to productive interaction/relational coproduction of care. The strength of the relationship between perceptions of quality of chronic care and relational coproduction among patients is strong (r=0.5; P≤0.001) and among professionals moderate (r=0.4; P≤0.001 relational coproduction with patients and informal caregivers). Furthermore, patients’ perceptions of the quality of chronic care were associated with the existence of productive interaction with health care professionals (β=0.7; P≤0.001). The changing nature of chronic care is associated with coproduction of care, leading to the development of more productive relationships between primary care professionals and COPD patients and their informal caregivers. Further research is necessary to determine how best to sustain these developments.

Les comorbidités dans la BPCO

COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.

Palliative care in COPD patients: A challenge in modern medicine.

Palliative care in COPD patients: A challenge in modern medicine.

Survey of Clinical Characteristics and the State and Respiratory Care in COPD Patients Admitted to Metropolitan General Hospital in Japan

Survey of Clinical Characteristics and the State and Respiratory Care in COPD Patients Admitted to Metropolitan General Hospital in Japan

How to care COPD patients from the point of view of the Certified Nurse in Chronic Respiratory Disease

How to care COPD patients from the point of view of the Certified Nurse in Chronic Respiratory Disease

P29 Impact Of Respiratory Virtual Clinics In Primary Care On Responsible Respiratory Prescribing And Inhaled Corticosteroid Withdrawal In Patients With Copd: A Feasibility Study

Introduction There is considerable variation in accuracy of diagnosis and long-term management of COPD in the UK. High rates of inhaled corticosteroid (ICS) prescribing have been reported, raising concerns about their over use, with less focus on high value interventions like stop smoking support/pulmonary rehabilitation. ICS are indicated in severe COPD patients (FEV 1 2 per year). Primary care data from SE London showed that 38% of COPD patients were over treated with high dose ICS, resulting in 12 additional cases of pneumonia, and costs >£500,000, annually. There is limited guidance on methods and feasibility of withdrawing ICS in these patients. Methods A responsible respiratory prescribing group including CCG medicines management, respiratory pharmacist and integrated respiratory team agreed COPD prescribing guidance across primary/ secondary care. GPs were supported with COPD review templates, written step down protocols and educational events. Virtual clinics with an integrated respiratory consultant/GP respiratory lead were offered to support ICS withdrawal in primary care. Results 45/48 (94%) of CCG practices took part. Data from 372 patients on COPD registers reviewed over 25 virtual clinics is presented. 321 (86%) patients had confirmed COPD (including 33 with COPD and asthma), 34 had asthma, 15 needed more spirometry and 2 had another diagnosis. 279/321 (87%) patients had a recommendation made: 64 (23%) referred for PR, 53 (19%) for spirometry, and 45 (16%) for smoking cessation. Changes to drug therapies were also recommended: 42 (15%) patients had a LAMA recommended, 16 (5%) a LABA, and while 117/321 COPD patients (37%) required no change to ICS therapy, a graduated step down/stop was suggested for 198 (63%). The outcomes associated with this are in Table 1. Overall, from Q4 13/14 prescribing data, there was a 4% decrease in high dose ICS (as proportion of total ICS use) resulting in a saving of £50,000. Conclusion Integrated working through respiratory virtual clinics offers hugescope to improve high value care for COPD patients. Overuse of ICS in COPD is common and GP-led withdrawal of high dose ICS where appropriate is feasible, acceptable and well tolerated by patients.

Correction: Primary Care COPD Patients Compared with Large Pharmaceutically-Sponsored COPD Studies: An UNLOCK Validation Study

Correction: Primary Care COPD Patients Compared with Large Pharmaceutically-Sponsored COPD Studies: An UNLOCK Validation Study

Analysis of Management of Noninvasive Ventilation Support in Prehospital Care for COPD Patients and Short-term Outcome

SESSION TITLE: Respiratory Support Posters

Variability of hospital resources for acute care of COPD patients: the European COPD Audit

Studies have suggested that larger hospitals have better resources and provide better care than smaller ones. This study aimed to explore the relationship between hospital size, resources, organisation of care and adherence to guidelines. The European COPD Audit was designed as a pilot study of clinical care and a survey of resources and organisation of care. Data were entered by clinicians to a multilingual web tool and analysed centrally. Participating hospitals were divided into tertiles on the basis of bed numbers and comparisons made of the resources, organisation of care and adherence to guidelines across the three size groups. 13 national societies provided data on 425 hospitals. The mean number of beds per tertile was 220 (lower), 479 (middle), and 989 (upper). Large hospitals were more likely to have resources and increased numbers of staff; hospital performance measures were related in a minority of indicators only. Adherence to guidelines also varied with hospital size, but the differences were small and inconsistent. There is a wide variation in the size, resources and organisation of care across Europe for hospitals providing chronic obstructive pulmonary disease care. While larger hospitals have more resources, this does not always equate to better accessibility or quality of care for patients.

Analysis of management of non-invasive ventilation support in prehospital care for COPD patients and short-term outcome

Benefits of the use of NIV in emergency departments are well established. Training and available staff, and choice of respiratory machines are essential criteria for success.

Palliative care in COPD patients: is it only an end-of-life issue?

The presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms. The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects.

P108 Healthcare Professionals Perceptions of Self Management in COPD – Important, Challenging and Misunderstood

IntroductionThere is increasing focus on the importance of self management (SM) within COPD. Literature from other chronic diseases highlights the challenges of implementing SM and the lack of specialist training...

PRS44 The Impact Made by the Continuity of Care for COPD Patients on Health Outcomes and Medical Cost in Korea, According to the National Health Insurance Database

To assess continuity of care and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, deaths and medical costs in Korea. This was a retrospective cohort study using the Korea National Health Insurance Claim Database. Patients, >40 years of age, who were diagnosed with COPD in 2007 (n=49,635) were monitored for four years, until 2010. As continuity of care increased, the risks of hospitalization, emergency department visits, and deaths decreased, as did medical costs. Also, variables that had significant affects on continuity level for COPD patients were gender, age, experience of hospitalization, frequency of ambulatory visits, number of institution visited, the type of the main clinics attended, and Charlson's score. The correlation analysis regarding continuity levels and odds ratios of health outcomes for COPD patients produced the following results. In comparison between the first quartile group and the fourth quartile group of COC, the fourth quartile group had higher rate of hospitalization by 1.61 (95% CI: 1.51-1.72), a higher emergency department usage by 1.53 (95% CI: 1.41-1.67), and an increased death rate by 1.26 (95% CI: 1.02-1.56). The odds of fourth quartile belonging to the high costing group were also higher than first quartile (OR=1.54, 95% CI: 1.44-1.64). The associations of COC with health outcomes and costs were stronger when analysing patients visiting a primary institution, as their main attending medical institution. As a result, it is proven that improving the continuity level reduces the risk of hospitalization, ER visits, deaths and medical costs in COPD patients. Therefore, policy makers needs to develop and actively move forward the program to improve the continuity level of care in patients with COPD, especially for the patients using the primary health care service.

Corrigendum

Corrigendum Siebeling L, Puhan MA, Muggensturm P, Zoller M, ter Riet G. Characteristics of Dutch and Swiss primary care COPD patients – baseline data of the ICE COLD ERIC study. Clin Epidemiol. 2011;3:273–283.Due to two duplicate records, the correct number of patients in the Ice Cold Eric study is 409, not 411. The reported results did not materially change. Those who wish to see the updated tables may contact the corresponding author.Read the original article

La BPCO : parent pauvre des soins palliatifs ?

The aim of our study was to examine the practices and performance of a team working in a respiratory unit concerning the palliative care of patients with COPD, in a group of patients who died in hospital as a result of their disease. The first step was focused on those patients who died in the respiratory care unit of the General Hospital of Saint-Nazaire during the year 2008 and who received end-of-life care, and the reasons for their death. In the second step, we selected and analysed retrospectively the records of patients who died from COPD. In the third step semi-directive interviews were held with a sample of nine care workers who were judged to be representative of the staff working in the respiratory ward of Saint-Nazaire Hospital. The interviews consisted of seven questions related to palliative practices and professional experiences acquired during the care of patients with COPD. In a population of 51 patients who received end-of-life care during the year 2008, 34 were referred on account of lung cancer and only one was referred for COPD. Bronchial carcinoma was the main cause of death (36 cases) then COPD (16 cases) in a total of 92 deaths (2008). Retrospective analysis of the records of patients who died from COPD showed a limitation of care in 43% of cases, midazolam induced sedation in 43%, treatment with morphine in 37%, support for the family or relatives in 62% and some anticipated decisions in 6%. Analysis of the interviews showed that the subject of death is rarely or never discussed with these patients in contrast to patients dying from bronchial cancer. The practices of a respiratory team concerning palliative care in COPD patients appear to be limited to end-of-life care. This clearly reflects a need for palliative care education in workers of respiratory care units in order to deliver a global palliative approach at an earlier stage in the care of COPD patients and to improve communication concerning end-of-life treatments.

Guía Española de la EPOC (GesEPOC). Tratamiento farmacológico de la EPOC estable

Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.

Spanish COPD Guidelines (GesEPOC): Pharmacological Treatment of Stable COPD

Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.

Effectiveness of Paced Walking to Music at Home for Patients with COPD

The use of rhythmic music is beneficial in assisting with the exercise intensity at home. This paper investigated the effects of paced walking to music at home with an 80% VO2 peak for patients with COPD. A prospective randomized clinical trial consisting of a treatment group (n = 20) assigned to a 12-week period of paced walking to music at home, while the patients in the control group (n = 21) were only given educational information. The treatment response was measured based on the patient's score in the maximal exercise capacity test using the incremental shuttle walking test (ISWT), lung function, health- related quality of life (HRQOL) using the Saint George Respiratory Questionnaire (SGRQ) and their health care utilization during baseline, 4, 8, 12 and 16 weeks. The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks (306.0 ± 107.3, p < 0.001), Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 (p < 0.001) at 16 weeks, and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 (p < 0.05) at 16 weeks, and improved all of the domains of the SGRQ, compared to the control group. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise.