Médecine interne: libre accès
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Abstrait

Effect of Nurse Home Visits on Extent of Follow-Up of Patients on Long Term Oxygen Therapy

Thomas J Ringbaek

Introduction: Guidelines recommend that patients on home oxygen therapy should be followed up regularly.
Study objective: To compare rate of follow-up at hospitals with opportunity to visit patients on home oxygen therapy at home to the rate of follow-up at hospitals without this facility.
Design and setting: A prospective study of patients on home oxygen therapy from five large hospitals. At three hospitals, a respiratory nurse followed up patients (n=774) either in the outpatient clinic or at home. At two hospitals, home visits of patients on home oxygen therapy (n=438) were not an opportunity. Study period was 4 months.
Results: Compared to hospitals without home visits, hospitals with home visits had followed up significant more patients (41.9% versus 23.3%; p<0.001). Among patients with a follow-up, the majority 388 (91.1%) had chronic obstructive pulmonary disease. Hospitals with home visits checked their patients more frequently in the study period (1.37 versus 1.05; p<0.001), compared to hospitals without home visits. Hospitals with home visits followed up more immobile patients who needed transport on a stretcher.
Patients with chronic obstructive pulmonary disease had higher mortality when they had a home visit compared to patients seen in the outpatient clinic despite the opportunity of home visit (50.6% versus 28.9% deaths; p=0.009), and higher mortality compared to patients with a follow-up by hospitals without the opportunity of home visits (50.6% versus 36.1% deaths; p=0.017).
One hundred sixty patients stated continuous oxygen therapy (15-24 hours/day) in the study period. Forty-three patients had oxygen therapy for at least 3 months without the recommend follow-up 15 (16.7%) versus 23 (40%) from hospitals with and without home visits, respectively.
Conclusion: More patients on home oxygen therapy are followed up, if the hospital has the opportunity to visit the frailest patients at home. This is likely to result in a more optimal oxygen therapy.