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The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD)
Author(s) -
Smith B. J.,
Appleton S. L.,
Bennett P. W.,
Roberts G. C.,
Fante P. Del,
Adam R.,
Trott C. M.,
Allan D. P.,
Southcott A. M.,
Ruffin R. E.
Publication year - 1999
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1999.tb01621.x
Subject(s) - medicine , copd , quality of life (healthcare) , outreach , emergency medicine , respiratory care , intervention (counseling) , randomized controlled trial , physical therapy , mortality rate , intensive care medicine , nursing , political science , law
Background : Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD. Aim : To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD. Methods : Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV 1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co‐operative Quality of Life questionnaire. Results : There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow‐up of FEV 1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV 1 (11% reduction, p =0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change. Conclusion : An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.