BMJ 2002;325:938 ( 26 October )

Primary care

Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease

Oshana Hermiz, project officer, ^a Elizabeth Comino, research fellow, ^a Guy Marks, director of respiratory medicine, ^b Kathy Daffurn, codirector of division of critical care, ^b Stephen Wilson, director ambulatory care, ^c Mark Harris, professor of general practice. ^a

^a School of Community Medicine, University of New South Wales, Sydney 2052, Australia, ^b Liverpool Health Service, Sydney, Australia, ^c Macarthur Health Service, South Western Sydney Area Health Service, Sydney, Australia

Correspondence to: M Harris m.f.harris{at}unsw.edu.au

Objectives: To evaluate usefulness of limited community based care for patients with chronic obstructive pulmonary disease after discharge from hospital.
Design: Randomised controlled trial.
Setting: Liverpool Health Service and Macarthur Health Service in outer metropolitan Sydney between September 1999 and July 2000.
Participants: 177 patients randomised into an intervention group (84 patients) and a control group (93 patients) which received current usual care.
Interventions: Home visits by community nurse at one and four weeks after discharge and preventive general practitioner care.
Main outcome measures: Frequency of patients' presentation and admission to hospital; changes in patients' disease-specific quality of life, measured with St George's respiratory questionnaire, over three months after discharge; patients' knowledge of illness, self management, and satisfaction with care at discharge and three months later; frequency of general practitioner and nurse visits and their satisfaction with care.
Results: Intervention and control groups showed no differences in presentation or admission to hospital or in overall functional status. However, the intervention group improved their activity scores and the control group worsened their symptom scores. While intervention group patients received more visits from community nurses and were more satisfied with their care, involvement of general practitioners was much less (with only 31% (22) remembering receiving a care plan). Patients in the intervention group had higher knowledge scores and were more satisfied. There were no differences in general practitioner visits or management.
Conclusions: This brief intervention after acute care improved patients' knowledge and some aspects of quality of life. However, it failed to prevent presentation and readmission to hospital.

What is already known on this topic Patients with chronic obstructive pulmonary disease often require hospital care and have impaired quality of life Home based care programmes provide viable alternatives to hospital admission for some patients at lower cost What this study adds A brief, home based nurse intervention after acute care improved patients' knowledge but failed to reduce subsequent presentations or admissions to hospital Additional interventions or interventions earlier in the disease process may be required to reduce hospitalisations

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