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Hospital-at-home care for exacerbations of chronic obstructive pulmonary disease: An observational cohort study of patients managed in hospital or by nurse practitioners in the community

Ansari, K.; Shamssain, M.; Farrow, M.; Keaney, N. P.

Authors

M. Shamssain

M. Farrow

N. P. Keaney



Abstract

The Urgent Care Team (UCT) in Sunderland (pop. 293,000) is a unique nurse practitioner service operating a hospital at home 24/7/365 to deal promptly with patients suffering an exacerbation of their COPD (AECOPD). Treatment is according to patient group directions utilising nebulised bronchodilators, doxycycline and prednisolone. To compare the health status and pathophysiology during and two months after an AECOPD in 60 UCT patients (31 male) and 30 hospital-managed patients (16 male). The St. Georges Respiratory Questionnaire (SGRQ), Mahler Baseline Dyspnoea Index (BDI) and MRC dyspnoea score recorded health status. Spirometry, BMI and grip strength were also measured. All patients were reviewed 2-3months after the AECOPD. Changes from BDI were measured using the Transitional Dyspnoea Index (TDI). Mean FEV1% predicted was 47%. In the recovery phase the two groups were comparable for all variables. But during their AECOPD hospitalised patients had a significantly lower BDI (P < 0.05) and an oxygen saturation ranging from 84 to 93% compared with 87-96% for UCT patients. Paired t-tests indicated that on recovery SGRQ activity domain and TDI measures improved in both groups. No deaths occurred during these AECOPDs. A hospital-at-home scheme for AECOPDs can deal with patients who have severe COPD safely. The Mahler TDI appears to be a sensitive index of improvement after an AECOPD. © 2009 SAGE Publications.

Journal Article Type Article
Online Publication Date May 1, 2009
Publication Date May 1, 2009
Deposit Date Mar 29, 2022
Journal Chronic Respiratory Disease
Print ISSN 1479-9723
Electronic ISSN 1479-9731
Publisher SAGE Publications (UK and US)
Peer Reviewed Peer Reviewed
Volume 6
Issue 2
Pages 69-74
DOI https://doi.org/10.1177/1479972309102728
Keywords Pulmonary and Respiratory Medicine
Public URL https://uwe-repository.worktribe.com/output/8256954