Source: Annual Congress 2002 - Chronic care and rehabilitation in the management of acute exacerbations
Disease area: Airway diseases

Abstract

Care strategies for exacerbations of COPD focus on economic arguments. A recent systematic review has, however, also suggested mortality and health related quality of life gains for patients with moderate COPD [Smith et al. Cochrane Database Syst Rev 2000]. We report a questionnaire returned by patients with recent COPD related admissions to (1) recognise patient concerns and preferences about outreach care and (2) relate findings to levels of dependence and quality of life (St Georges Respiratory Questionnaire, SGRQ). Over 18 months to April 2000 there were 487 COPD admissions (n=349 patients) with mean duration of stay 7.39 (SD 5.5) days. 247 (71%) patients responded. Mean age was 69.4 (SD 10.9) years with 55% males. 50 (20.2%) patients were prescribed long term oxygen, 83 (34%) nebulisers, with 32 (13%) both. 78 (32%) patients lived alone and 65 (26%) employed extra-help. Whereas only 92 (37%) of patients considered admissions could be managed at home, it was the preferred option for 139 (56%). Concern was about provision of oxygen (20%), nebulisers (15%), difficulties living alone (10%), and medications (12%). Responses from 174(50%) patients provided for quality of life measures. Quality of life scores (0-100, with 100 worst) were Symptoms (75.1), Activity (84.7), Impact (62.8), and Total Score (71.5). Patients considering a supported discharge feasible had better scores for symptoms (69.8 vs 78.0, p=0.02), activity (80.1 vs 86.9, p=0.05) and total score (58.6 vs 64.8, p=0.04) but not for impact (58.0 vs 64.8). There were no differences, however,when considering those expressing their preference (home vs hospital) for future management. Outreach schemes among patients with COPD appear patient supported.

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Citations should be made in the following way:
M. Whiting, R. Hayton, H. Moudgil (Telford, United Kingdom). Supported discharges for exacerbations of chronic obsrtructive pulmonary disease (COPD): patient preferences and quality of life measures. Eur Respir J 2002; 20: Suppl. 38, 3712

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