PRESCRIPTION OF OXYGEN CONCENTRATORS AND SURVIVAL IN NORTHERN-IRELAND

Long term oxygen therapy (LTOT) has been shown to prolong survival and to improve quality of life in patients with chronic obstructive pulmo nary disease (COPD) and in respiratory failure, In Northern Ireland ox ygen concentrators have been available on prescription since August 19 86, initially on a restricted basis from hospital physicians only, Thi s was followed by open prescribing from April 1989, when concentrators could be prescribed by general practitioners, This study examined pre scribing habits of LTOT during both periods, and patient survival, Cas e notes of all prescriptions of oxygen concentrators in Northern Irela nd (to April 1991) were reviewed, Prescription criteria and advice reg arding usage during both periods were analysed, A questionnaire survey of subjects during open prescribing documented the advice given at th e time of prescription and current usage, 164 charts of 178 total inst allations were available for review, During both periods many concentr ators mere installed without adherence to the prescribing criteria at the time (75% restricted, 48% open), The majority of these were on the advice of a consultant respiratory physician and only 14 were prescri bed directly by GPs, 89 of 91 subjects receiving current LTOT during t he study period completed questionnaires, Of the subjects prescribed L TOT during the restricted period, 2 subjects are still alive (median s urvival 19 m, range 0-104), From the open period, survival data was av ailable on 107 of 129 subjects with 17 still alive (median survival 22 m, range 0-94), This study documents an inadequate rate of prescribin g and a lack of conformity to guidelines in the provision of LTOT in N orthern Ireland, We would suggest that familiarisation with the prescr ibing criteria, formal written advice at the time of prescription, app ropriate follow up to ensure adequate supplementation and regular pati ent education on the use of LTOT would address these problems to a sub stantial degree.