Authors (including presenting author) :
Sze CW(1), Emily Leung(1), Liu KN(1), Chan SY(1), Law MW(1), Liu YT(1), Tai CL(1), Wan YY(1), Mandy Tai(1), Sin KM(1)
Affiliation :
(1)Respiratory Medicine Division, Department of Medicine and Geriatrics, Tuen Mun Hospital, NTWC
Introduction :
Chronic obstructive pulmonary disease(COPD) is a chronic illness not only weighing significant burden of morbidity and mortality on patients, but also presenting a big challenge to healthcare utilization in a resources-limiting setting. Our unit has been carrying out COPD Patient Empowerment Program since August 2018. The aim is to empower patients on self-management with a focus on effectiveness as well as safety. We hereby presented 3-year results of the program.
Objectives :
To identify the demographics of COPD patients in our unit. To evaluate the effectiveness and safety of the program after 3 years of patient recruitment.
Methodology :
Patients with COPD were recruited in both inpatient and outpatient settings in Department of M&G, Tuen Mun Hospital. For inpatient setting, patients were recruited when they were hospitalized with a primary diagnosis of COPD exacerbation. For outpatient setting, COPD patients attending follow-ups in Nursing Clinic and Specialist Outpatient Clinics (SOPC) were recruited. The empowerment program incorporated disease education, inhaler techniques reinforcement, smoking cessation, nurse clinic bridging follow-ups, rescue pack (i.e. short course(s) of oral antibiotics and prednisolone) prescription, red flag identification and case manager's hotline. Patients were recruited from August 2018 till August 2021. Healthcare facilities utilization was defined by Accident & Emergency (A&E) attendance, hospitalization, emmergency ward (EMW) admission and General Outpatient Clinics (GOPC) attendance. Healthcare facilities utilization was compared 90 days before and 90 days after recruitment. We also retrospectively collected all-cause mortality data within 90 days of post recruitment. Data was analyzed using Stata 15.1 software.
Result & Outcome :
Baseline characteristics: 737 patients (353 outpatient, 384 inpatient) were included in the analysis. 21 inpatients were excluded as they did not survive the index admissions and hence post 90 days data not available. 96% were male. Age was slightly skewed with mean age of 72 years. 19% were current smokers while 77% were ex-smokers. Mean COPD Assessment Test (CAT) score was 14.5 while 51.4% belonged to COPD Group D. 60.5% of patients were using triple therapy (LABA/LAMA/ICS) of variouis inhaler combinations. 26.2% received roflumilast. 173 patients (23.5%) were using long term oxygen therapy while 28 patients (3.8%) were using home non-invasive ventilation (NIV). 44.3% patients were prescribed rescue pack medications as part of the empowerment program.
Results: Wilcoxon signed rank test showed that overall the empowerment program was significantly associated with lower helathcare utilization in the post-recruitment period (p=0.0048). Multiple logistic regression showed that history of previous healthcare utilization (p< 0.001), long term oxygen therapy (LTOT) (p=0.025) and advanced COPD group (p=0.009) predicted higher subsequent healthcare facilities utilization rate whereas a longer duration (more than 7 days) of rescue pack prescription (p=0.004) predicted lower healthcare facilities utilization. Of 410 patients who were not prescribed rescue packs, 21 patients (0.051%) were dead within 90 days of post recruitment. Of 326 patients who were given rescue packs, only 1 (0.003%) was dead post 90 days. Chi square test showed that rescue pack prescription was significantly associated with lower mortality (p< 0.001). Multiple logistic regression revealed that advanced age (p=0.001) and baseline home NIV use (p=0.001) predicted higher post 90 days mortality while rescue pack prescription (p=0.014) was associated with lower mortality in the post 90 days period.
Conclusion: COPD Patient Empowerment Program is effective in reducing unnecessary healthcare facilities utilization. Self management with rescue pack is safe for COPD patients and is associated with lower mortality.
