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Can an integrated COPD team using a hospital at home service help reduce the burden on primary and secondary care resources?

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Can an integrated COPD team using a hospital at home service help reduce the burden on primary and secondary care resources?

Small scale hospital at home study for patients with COPD aimed at reducing or altering treatment of acute exacerbations which could result in hospital admission.

Author: H. Meredith, M. Hodson and A. Bhowmik
Journal: American Journal of Respiratory and Critical Care Medicine  2011  183 (1 MeetingAbstracts) 
Year:  2011

Rationale: The economic burden of chronic obstructive pulmonary disease (COPD) is high and the pressure on primary and secondary care resources is ever rising. Hospital at Home (HaH) schemes has been shown to be popular with patients and equally safe in appropriate patients as hospital care.
In addition they may reduce the burden on resources in acute exacerbations of COPD, but it can be difficult to show this.
Method: We identified 45 consecutive patients, with previously diagnosed COPD, over a 4 month period in our district general hospital. They were self referred, referred by primary care or the emergency department to our HaH team for an acute exacerbation of COPD.
They were phoned by a healthcare professional not involved in their care within a few weeks of their discharge from that event, and they underwent a telephone questionnaire. We asked what other healthcare alternatives they would have used if they had not been managed by this service. 24 answered, 1 declined, and we were unable to contact or complete a questionnaire over the telephone with the remainder.
Results: (Table presented) Only 3 patients were admitted to hospital following their care under the HaH team (2 of these referred by HaH) and 3 chose to see their primary care physician in addition to being seen by the team. This patient group had a mean length of care of 6 days (1-17) under the HaH team, with a mean number of 3 (0-10) home visits and 2 (0-11) phone calls, after their initial triage phone call. They were mainly female (66%), had an age range of 51 to 82, and were predominantly frequent exacerbators with 20 patients (83%) reporting an exacerbation rate of 3 or more a year. The table below shows the estimated costs or tariffs in our region for other forms of intervention.
Costs: Service: Cost (UK sterling) : Primary care consult (estimate from Personal Social Services Research Unit- 2009) 35 London ambulance call out charge (cost from ambulance service) 221 'Standard' emergency department attendance (national tariff) 106 In patient stay <24 hours (national tariff) 580 In patient stay for non complicated COPD exacerbation 1-13 days (national tariff) 2256 Average package of 5 hours total care with HAH team (Band 6 nurse + costs) 120
Conclusion: The majority of this patient group reported that if they'd not been seen by the HaH team they would have sought a review from another healthcare practitioner; with just over half choosing to be assessed in secondary care with its higher cost implications. Whilst this is a small group and we can only collect retrospective data regarding what our patients report they would have done, we believe our study indicates that the majority of these patients using our scheme would have used considerable other healthcare resources had they not had the HaH available to them.

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