Assessment of health status and program performance in patients on long-term oxygen therapy - 11/03/15

Doi : 10.1016/j.rmed.2015.01.005

Carme Hernandez ^a,^f,^⁎ , Jesús Aibar ^a, Jordi de Batlle ^b, David Gomez-Cabrero ^c, Nestor Soler ^a, Enric Duran-Tauleria ^d, Judith Garcia-Aymerich ^d, Xavier Altimiras ^e, Monica Gomez ^a, Alvar Agustí ^a, Joan Escarrabill ^a,^f, David Font ^a, Josep Roca ^a
The NEXES Consortium
^a Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain
^b International Agency for Research on Cancer (IARC), Lyon, France
^c Unit of Computational Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden
^d Centre de Recerca en Epidemiologia Ambiental (CREAL), CIBER en Epidemiologia y Salud Pública (CIBERESP), Department of experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
^e Consorci Sanitari de Barcelona, Servei Català de la Salut, Generalitat de Catalunya, Spain
^f Master Plan for Respiratory Diseases (PDMAR) and Respiratory Therapies Observatory (ObsTRD), Ministry of Health and REDISSEC (Research Network in Chronic Care), Barcelona, Catalonia, Spain

^∗Corresponding author. Atenció Integrada, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERES, Villarroel 170, 08036 Barcelona, Spain. Tel.: +34 93 2279368; fax: +34 93 2275455.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 11 March 2015

Summary

Background

Despite well established clinical guidelines, performance of long-term oxygen therapy (LTOT) programs shows marked variability among territories. The current study assessed the LTOT program and the health status of patients on LTOT prior to the deployment of community-based integrated care in an urban health district of Barcelona (Spain).

Aims

To assess: i) the LTOT program and health status of the patients on LTOT in the health district; ii) their frailty profile; and, iii) the requirements for effective deployment of integrated care services for these patients.

Methods

Cross-sectional observational study design including all patients (n = 406) on LTOT living in the health district. Health status, frailty, arterial blood gases, forced spirometry and hand-grip muscle strength were measured. Network analysis of frailty was carried out.

Results

Adequacy of LTOT prescription (n = 362): 47% and 31% of the patients had PaO₂ ≤ 60 mmHg and ≤55 mmHg, respectively. Adherence to LTOT: 31% of all patients used LTOT ≥15 h/d; this figure increased to 67% in those with PaO₂≤60 mmHg. Assessment of frailty: Overall, LTOT patients presented moderate to severe frailty. Care complexity was observed in 42% of the patients.

Conclusions

Adequacy and adherence to LTOT was poor and many patients were frail and complex. The outcomes of the network analysis may contribute to enhance assessment of frailty in LTOT patients. These observations suggest that an integrated care strategy has the potential to improve the health outcomes of these patients.

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Keywords : Continuous oxygen therapy, Adequacy, Adherence, Chronic patients, Frailty, Integrated care