Authors (including presenting author) :
Sze CW(1), Tai CE(1), Leung SL(1), Sin KM(1)
Affiliation :
(1) Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Chronic Obstructive Pulmonary Disease (COPD) is a common disease and a major cause of recurrent Accident and Emergency Department (AED) attendances as well as hospital admissions. Since August 2018, our unit recruited patients with COPD to the Patient Empowerment Program (PEP). After 12 months of recruitment, we analysed and reported the interim results.
Objectives :
(1) To reinforce patients' knowledge of the disease and medications, inhalers technique and smoking cessation; and
(2) To empower them with self-management (with or without rescue pack medications) and identification of red flag signals; and
(3) To reduce unnecessary healthcare utilization for COPD exacerbations.
Methodology :
Patients with COPD were recruited in both in-patient and out-patient settings from August 2018 to July 2019. Healthcare utilization was defined by General Outpatient Clinic (GOPC) attendance, AED attendance, Emergency Ward (EMW) stay or hospital admission due to acute exacerbation of COPD. These patients' healthcare utilization statistics were compared between 90 days before and 90 days after empowerment.
Result & Outcome :
From August 2018 to July 2019, total 372 patients (154 in-patients and 218 out-patients) were empowered. Mean age was 71 years old (from 44 to 93) and 97.3% were male. 78.2% had significant symptoms with COPD Assessment Test (CAT) score of 10 or above. 58.4% belonged to group D according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) definition. 59.5% were give rescue pack medications. For pre-90 days healthcare utilization, there were totally 635 episodes and the mean was 1.71 episode per patient. For post-90 days, there were 481 episodes in total and the mean was 1.31 episode. Paired t-test showed that the reduction was significant (p = 0.002). There was a 24.3% reduction in healthcare utilization in the period studied. Multiple logistic regression analysis revealed the strongest predictors for healthcare utilization were previous history of utilization (p < 0.001) and age (p = 0.024) whereas rescue pack medications significantly reduced healthcare utilization (p = 0.043).
