The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD)

Background: Chronic obstructive pulmonary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. Wit h the increasing interest in outreach care programmes it is important to ev aluate their impact upon patients and health services, for conditions such as COPD. Aim: To determine the effectiveness of an outreach respiratory nurse in a s hared care approach, with collaboration between general practitioners and h ospital services, in the management of patients with severe COPD. Methods: Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nurs ing intervention (HBNI) over 12 months with outcome measures including mort ality rate, hospital service utilisation, FEV1 and health related quality o f life (HRQL) using a modified Dartmouth Primary Care Go-operative Quality of Life questionnaire. Results: There were 48 subjects in each study arm, with no differences in m ortality rate (eight deaths in the HBNI group and seven in the control grou p), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow-up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL tin three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change. Conclusion: An increased level of care given by an outreach respiratory nur se in a shared care approach for patients with severe COPD produced small i mprovements in HRQL but did not result in the prevention of deaths or reduc ed health care utilisation.