Assessment of the Effects of an Intermediate Care Package in Preventing Hospitalisation of Patients With COPD
Condition: COPD
Study type: Interventional

Summary: 
      Chronic obstructive pulmonary disease (COPD) is a term used for the conditions of chronic
      bronchitis and emphysema, diseases that are very common among the elderly and diseases that
      account for up to15% of all general medical admissions to National Health Service Hospitals.
      In a recent report on emergency admissions to acute hospitals in London, the King's Fund
      concluded that taking better care of elderly patients with COPD could reduce pressures on
      acute hospitals, and suggested that identification of vulnerable patients with lung disease
      and "pro-active," rather than "reactive," management might reduce the chances of
      hospitalisation. In this study, the investigators wish to compare a group of patients with
      COPD who are managed in the normal way, with another group of patients with COPD who receive
      all interventions known to be of some benefit to those with this condition. This will include
      a pulmonary rehabilitation programme, intensive education regarding self care, targeted
      advice to their general practitioners regarding how best to manage COPD, and regular contact
      with specialist respiratory nurses who will support the patients in their own homes by a
      combination of home visits and telephone contact. The value of such a comprehensive
      intervention will be studied, in terms of both its ability to reduce admissions to the
      hospital and its impact on quality of life.
    

Detailed description: 
      One hundred twenty-two patients over the age of 50 with COPD, admitted to Charing Cross
      Hospital in 2000-2004 with an acute exacerbation of their condition will be recruited and
      randomised to routine and opportunistic care (n= 61) vs study care package (n=61) for 2
      years. The patients randomised to the study package will take part in an initial pulmonary
      rehabilitation programme of 8 sessions of physical therapy and education (2 sessions a week
      for 4 weeks). Health related quality of life will be measured in the intervention and routine
      care groups using validated instruments (SF-36 and Canadian Respiratory Diseases
      Questionnaire). This will be followed by a baseline home visit and assessment from an
      experienced specialist respiratory nurse (Grade G), followed by monthly telephone calls and a
      home visit every 3 months. Each interview and visit will be a structured intervention
      addressing specific issues related to the management of COPD, with four possible specific
      outcomes including history taking; measurement of vital signs; discussion of treatment;
      appropriate vaccination and discussing and reinforcing self-management education. At the end
      of the 2 year study period the routine care and intervention groups will be compared for the
      following outcomes: number of admissions to hospital for exacerbations of COPD; number of
      unplanned visits to a general practitioner (with those initiated by study nurse identified
      separately); measures of quality of life (SF-36; CRDQ).
    

Intervention name(s): Intermediate care package
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Keywords: COPD