Nurse-led self-management of COPD exacerbations reduces mortality and is cost effective

Abstract

A Nurse-Led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease.

Objectives

To determine the effects of a nurse-led intermediate care programme in the management of patients who have been hospitalised with an acute exacerbation of COPD (AECOPD).

Design

Randomised controlled trial.

Setting

Care in the community and a teaching hospital in West London.

Participants

One hundred and twenty-two patients who had been admitted to Hammersmith Hospitals NHS Trust with a diagnosis of AECOPD.

Intervention

A care package incorporating initial pulmonary rehabilitation and self-management education followed by the provision of a written, personalised COPD action plan, monthly telephone calls and three monthly home visits by a specialist nurse for a period of two years.

Main outcome measure

Hospital readmission rate.

Secondary outcomes

Unscheduled consultations with general practitioners and disease-specific health-related quality of life.

Results

There were no differences in hospital admission rates or in exacerbation rates between the intervention and control groups. Self-management of exacerbations was, however, significantly different and patients in the intervention group were more likely to have exacerbations treated with oral steroids alone or oral steroids and antibiotics than the control group, and the initiator of treatment for exacerbations was statistically more likely to be the patient themselves in the intervention group. Twelve patients in the control group died during the two-year period, eight as a result of COPD, compared with six patients dying in the intervention group, of which one died from COPD. This is a significant difference. When the numbers in the intervention and control groups are adjusted to reflect the numbers still alive, at two years, 55 of the 61 patients of the intervention group were still alive and these patients had had a total of 171 unscheduled contacts with their GP. In the control group, 49 of the 61 patients were still alive and they had 280 contacts with their GP. The number needed to treat equals 0.558. That is to say, for every one COPD patient receiving the intervention and self-management advice, there was 1.79 less unscheduled contacts with the GP. There were no important differences in quality of life.

Conclusions

An intermediate care package incorporating pulmonary rehabilitation, self-management education and the receipt of a written COPD action plan, together with regular nurse contact, is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate.

Reproduced with permission from the BMJ Publishing Group.