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Arch Phys Med Rehabil. 2009 Mar;90(3):395-401. doi: 10.1016/j.apmr.2008.08.223.

A specific home care program improves the survival of patients with chronic obstructive pulmonary disease receiving long term oxygen therapy.

Author information

1
Servizio di Fisiopatologia Respiratoria, Ospedale Luigi Sacco, Via Grassi, Milano, Italy.

Abstract

OBJECTIVES:

To analyze the influence of a home care (HC) program on outcomes of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) in comparison with outcomes of patients receiving standard care (SC).

DESIGN:

A 10-year follow-up study with 2 parallel cohorts (HC vs SC).

SETTING:

University hospital.

PARTICIPANTS:

One hundred and eight patients in the HC program and 109 patients managed conventionally.

INTERVENTIONS:

The HC program consisted of outpatient clinical and functional evaluations every 6 months, and domiciliary assessments by a specific team including a pneumologist, a respiratory nurse, and a rehabilitation therapist every 2 to 3 months or more, as needed.

MAIN OUTCOME MEASURES:

Mortality; exacerbation, hospital and intensive care unit admission rate.

RESULTS:

One hundred and eight patients entered the HC program and 109 patients were managed conventionally. The 2 groups of patients did not differ for age, sex, body mass index, COPD severity or comorbid conditions. The overall mortality during the follow-up was 63% and the median survival was 96+/-38 months. The survival curves for HC and SC patients were statistically significantly different (log-rank, -16.04; P=.0001). In the Cox proportional hazards model, inclusion in the HC program was associated with an increased survival rate, whereas comorbid conditions and requirement of mechanical ventilation during the follow-up were associated with a decreased survival rate. During the entire follow-up, HC patients had a lower number of exacerbations/year than SC patients.

CONCLUSIONS:

A disease-oriented HC program is effective in reducing mortality and hospital admissions in COPD patients requiring LTOT.

PMID:
19254602
DOI:
10.1016/j.apmr.2008.08.223
[Indexed for MEDLINE]

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