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2012

2012 June - Impact of a COPD self-management program on healthcare utilisation

Dr Wing-Yan CHU; Department of Medicine, North District Hospital

Background
Acute chronic obstructive pulmonary disease (COPD) exacerbations often leave considerable effects on patients’ lung function and health status. An educational approach that encourages patients to detect changes in symptoms and empowers patients to self-manage exacerbations early has the potential to improve exacerbation outcomes and reduce healthcare utilisation. At North District Hospital, a Respiratory Collaborative Care Team (RCCT) was established in 2009 to support patients in self-management that includes education on the use of stand-by courses (crisis management packs) of antibiotics and corticosteroids.

Objectives
1. To study the effect of a COPD self-management programme on healthcare utilisation
2. To study the safety issues of self-administered corticosteroids and antibiotics

Methods
Clinical records of RCCT patients prescribed crisis packs from January 2009 to December 2010 were reviewed. Demographics and characteristics of patients, number of hospital admissions and emergency department visits, causes of admissions one year before and after the start of crisis pack prescription were analysed. Incidence of pneumonia and adrenal insufficiency and emergence of drug-resistant respiratory pathogens after the practice of crisis pack prescription were reviewed.

Results
A total of 316 patients had been prescribed crisis packs during the study period and 167 patients were eligible for analysis. Health care utilisation rate, including both hospitalisations and Accident and Emergency Department (AED) visits related to COPD, was significantly reduced by 29.2% (p<0.001) after crisis pack introduction. COPD-related hospitalisation was also significantly reduced by 34.5% (p<0.001). Mean incidence of pneumonia was similar before and after crisis pack practice (0.14 vs 0.13, p=0.752). Three patients (1.4%) had antimicrobial resistance that developed in the same species of respiratory pathogens and 30 patients (9.5%) had acquired a new resistant pathogen. Three patients developed adrenal insufficiency requiring oral hydrocortisone supplement.

Conclusion
An educational programme that empowers patients to self-manage COPD exacerbation with crisis pack successfully reduced the health care utilization. However, risks associated with the development of resistant respiratory pathogens and adrenal insufficiency remained. Further trials and ongoing monitoring of such risks are needed.

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