Effect of telemonitoring on quality of life for patients with chronic obstructive pulmonary disease-A randomized controlled trial.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) often experience severe physical limitations and psychological distress, which can lead to a deterioration in quality of life (QoL). Telemonitoring (TM) may improve QoL and reduce the number of hospitalizations and readmissions, but results from previous studies have been conflicting. The aim of this study was to assess the effect of TM on QoL in patients with moderate to severe COPD recruited during hospitalization for acute exacerbation (AECOPD). METHODS: We conducted a randomized controlled trial at Silkeborg and Viborg Regional Hospitals in Denmark. Participants were recruited during hospitalization for AECOPD and randomized to a six-month telemonitoring service in addition to standard COPD care or standard COPD care alone. Patients were followed for 24 months. QoL was measured by the Hospital Anxiety and Depression Scale (HADS), and St Georges Respiratory Questionnaire (SGRQ) at 3-, 6-, 12-, and 24-months follow-up. The main outcome was QoL at 6 months. RESULTS: In total, 101 patients were randomized to the TM intervention and 97 to standard care. The between-group difference in SGRQ at 6 months was -2.0 (-8.5; 4.5), in HADS-Anxiety -0.3 (-2.0; 1.4) and in HADS-depression 0.2 (-1.0; 1.4) corresponding to no significant difference in health-related QoL for patients receiving TM compared to standard care. No difference was seen at 12-24 months follow-up either. DISCUSSION: TM in addition to standard care did not improve QoL in patients with moderate to severe COPD. Other means of improving management and QoL in severe COPD are urgently needed.

Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines.

BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease. DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included in the two surveys. RESULTS: The proportion of patients having FEV(1) registered in the GPs files increased from 45% to 69% (P < 0.001); and, furthermore, FEV(1) % of predicted was recorded in 30% and 56%, respectively, of the cases (P < 0.001). In line with this, significant improvements were also observed for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P < 0.001). Concerning the management options, improvements were also observed with regard to antismoking counseling, inhalator technique, physical activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%. CONCLUSION: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved by focused education of GPs and their staff.

[The quality of COPD care in general practice]. / Kvaliteten af diagnostik og behandling af kronisk obstruktiv lungesygdom i almen praksis--sekundaerpublikation.

We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p < 0,001) and improvement in other parameters describing the quality of management. We conclude that participation in an educational programme can improve the quality of COPD care in general practice.

[Nurse-supported discharge of patients with exacerbation of chronic obstructive pulmonary disease]. / Sygeplejeassisteret hjemmebehandling af eksacerbation i kronisk obstruktiv lungesygdom.

BACKGROUND: The study was conducted to investigate the safety of "hospital at home" versus hospital care. MATERIALS AND METHODS: It was a prospective randomised controlled trial. Patients with an exacerbation of chronic obstructive pulmonary disease (COPD) were included and randomised to supported discharge (n = 22) or to conventional in-patient care (n = 22). Outcome measures were readmissions, complications, mortality within 60 days of initial admission. RESULTS: 390 patients (COPD) were admitted and 44 patients (12%) were included in the study. In the home treatment period 2 patients (9%) were readmitted. One patient (4.5%) died 2 weeks after discharge from the home treatment. In the follow-up period 3 patients in the home treated group were readmitted 7 times (31.8%), and 7 patients in the conventional in-patient group were readmitted 9 times (40.9%). There were 14 complications (63.6%) in the home treated group and 15 complications (68.3%) in the conventional in-patient group. The length of hospital stays in the supported discharged group were shorter (1.3 (std = 0.5) versus 3.7 (std = 2.8) days, p = 0.002). After discharge a respiratory nurse visited supported discharged patients at home during 5.1 days (min. 2 days, max. 13 days) with 2.6 visits per patient (min. 1, max 6 visits). CONCLUSION: This study shows that home supported discharge is a well tolerated, safe and economic alternative to hospital admission for a proportion of patients referred to hospital for admission for COPD.

The quality of COPD care in general practice in Denmark: the KVASIMODO study.

AIM: We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence to COPD guidelines. METHODS: We performed two audit surveys of GPs' patients' notes, one year apart, before and after an educational programme for participating GPs and their staff. A total of 154 GPs participated in the study. 2549 patient records were included in the first survey and 2394 in the second. RESULTS: Based on analysis of all patient records, we observed a substantial improvement in the quality of care: recording of FEV1 improved from 52.7% of cases in the first survey to 71.4% in the second (p< 0.001). There was a significant improvement in the recording of body mass index and provision of smoking cessation advice, recommendation of physical activity, checking of inhalation technique, dietary instruction, and referral to pulmonary rehabilitation. We also found a decline in the use of inhaled corticosteroids in patients with mild COPD, from 60.2% in the first survey to 48.8% in the second. When analysing the results focussing on the performance of single GPs there was an improvement in quality, but this was less than the improvement for patients overall - suggesting that improvement in quality of care was not equally distributed throughout the GPs' practices. CONCLUSION: We conclude that it is possible to improve the quality of COPD care by educating GPs and their staff.

[Cystic fibrosis in a 70-year-old woman]. / Cystisk fibrose hos en 70-årig kvinde.

Cystic fibrosis is usually diagnosed in early childhood, and patients rarely live beyond the age of 40. We present a case of a 70-year-old woman, in whom cystic fibrosis was diagnosed with the rare mutation, R117C. Cystic fibrosis should therefore also be considered in older patients.