The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ROLE OF MANAGEMENT PATHWAY IN THE CARE OF ADVANCED COPD PATIENTS IN THEIR OWN HOMES

Ashok A. Ramani1,2, Anthony A. Pickston1, James L. Clark1, Courtney A. Clark1, Michael Brown2



Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide and the incidence and prevalence is rising every decade. The cost of hospital admissions is substantial and is the single largest source of expenditure in COPD patients. Home-based intervention has been shown to provide long-term cost benefits in a range of chronic illnesses. The role of home visits by respiratory therapist in COPD management has not been evaluated. The aim of this study was to assess the effectiveness of management pathway in the care of advanced COPD patients in their homes.

Methods:
Advanced Oxygen dependent COPD patients were enrolled in the management pathway after discharge from the hospital or referred from the office and followed for almost a year. At least three home visits were made; the first within 3 days of enrollment, second one month and the third ten months later.

Results:
Three hundred and twenty four patients were enrolled in the study. During the study period overall hospitalization rate dropped (11% per month in the second visit versus 2.1% per month in the third visit). Understanding of the disease improved substantially (21.6% vs. 83.96%), knowledge of medications they were on improved (56% vs. 87%), and appropriate use of medications increased (52% vs. 86%).

Conclusions:
In our community this respiratory therapist (RT) led program helps patients' self-management of COPD in their own homes by increasing understanding of the disease, assists physicians in monitoring their patients and reduces hospitalization.