Appropriateness of domiciliary oxygen delivery

Objective: Almost every country in the developed world has a domiciliary ox ygen program. Whether recipients meet program criteria has not been rigorou sly studied. Design: Cross-sectional survey. Participants: Two hundred thirty-seven patients receiving domiciliary oxyge n in the Ontario Ministry of Health Home Oxygen Program (HOP). Methods: A respiratory therapist visited the patients' homes and administer ed questionnaires, obtained resting arterial blood gas measurements, and co nducted a standardized home exercise test while monitoring oxygen saturatio n using an oximeter. Measures of outcome: We evaluated the extent to which patients met HOP crit eria that are based on the inclusion criteria of randomized trials showing the life-prolonging effects of domiciliary oxygen. We also assessed the ext ent to which the patients' oxygen prescription was consistent with the resu lts of rest and exercise testing. Results: Ninety-six of 237 participants (40.5%; 95% confidence interval, 34 .3 to 46.8) did not meet criteria for home oxygen. Patients aged less than or equal to 70 years were more likely to meet criteria (71 of 105 patients; 67.9%) than those > 70 years old (70 of 132 patients; 53.0%). The proporti on of patients meeting criteria was similar whether the referring physician was a specialist (71 of 112 patients; 62.5%) or a primary-care physician ( 69 of 123 patients; 56.1%). A very important health benefit from oxygen was identified among 82% of those who met criteria and 88% of those who did no t. Patients received higher flow rates than our criteria suggested were app ropriate. Agreement between the independently assessed oxygen prescription at rest and the patients' report of oxygen use was extremely poor (chance-c orrected agreement [kappa], 0.17), as was agreement concerning optimal exer cise flow rates (kappa, 0.26). Conclusions: Current procedures for administration and reimbursement of hom e oxygen result in a large proportion of recipients not meeting criteria, a s well as the prescription of excessive oxygen flow rates. These results ar e likely to apply to many jurisdictions and suggest a large potential for m ore efficient resource allocation.