COPD is a progressive lung disease whose symptoms include shortness of breath, coughing, wheezing and recurrent respiratory infections. As the disease progresses, many patients suffer 'exacerbations', which typically involve a sudden worsening of the symptoms and, in the most severe cases, can lead to respiratory failure. Exacerbations are treated with bronchodilators, antibiotics and steroids.
Hospital admissions due to exacerbations represent a major problem for healthcare systems, as they generally worsen the patients' quality of life and place a significant economic burden on hospitals.
Researchers in Barcelona, Spain and Leuven, Belgium designed an alternative, integrated care system aimed at reducing levels of hospitalisation among COPD patients. They then assigned patients who had been hospitalised due to COPD at random to either the usual follow-up system or the new integrated care system.
Under the integrated care system, on discharge from the hospital a comprehensive assessment of the patient looked at the severity of the patient's COPD, other health problems and social support needs. A two hour course on COPD provided patients with information on the disease in general, tips on how to better manage their symptoms and strategies for coping with future exacerbations. Following that, an individually tailored care plan was designed and distributed to all involved in the patient's treatment. Finally, both patients and carers were provided with access to a specialised nurse through a web-based call centre which was designed by the EU-funded CHRONIC project. Regular follow-up phone calls served to remind patients of the self-management strategies.
Patients in the usual care system were discharged from hospital and followed up by their doctor as normal, without the extra support offered to the integrated care patients. All patients in the study were followed for one year.
The researchers found that patients in the integrated care group were less likely to be re-hospitalised than those in the usual care group. The researchers attribute the success of the integrated care group to an enhanced self-management of the disease, higher levels of access to healthcare professionals, and greater levels of cooperation between health care professionals from a range of sectors. Their results are published in the European Respiratory Journal.
A total of 60 per cent of patients admitted in emergencies have a chronic pathology. Treating these patients at the appropriate level can reduce pressures on hospitals and improve patients' quality of life, said the researchers.
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