Comprehensive Management Program in COPD Patients
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2010-04-09
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Thai Journal of Tuberculosis Chest Diseases and Critical Care
Abstract
Background: Chronic obstructive pulmonary disease (COPD) was non-communicable disease which gradually increasing incidence. The mortality might be twice in the next decade and also the trend of ER visit and admission rate. These resulted in higher cost of treatment. Until now, there was no best holistic clinical practice guideline for the general practitioners. The establishment of holistic clinical practice guideline for COPD management might be the best for both patients and physicians. Objective: To assess outcome of treatment before and after apply the comprehensive management program in COPD patients. Setting: Uttaradit Hospital. Study design: Prospective cohort study. Method: Prospective study was conducted in COPD patients during November 2007 to October 2008 compared to pre-protocol period. Results: There were 137 COPD patients included in the study. Six patients were excluded. Their mean age was 68 years old. Most of them (79%) were male. Smoking was the major risk factor. Less than half of them had underlying disease with hypertension the most common. The mean BODE index was 3.14. Their pulmonary function test results were classified as moderate to severe disease. Male dyspneic scale (Modified Medical Research Council scale, MMRC) was higher than female but not correlated with the severity of disease. Rescued bronchodilator therapy was a main treatment in these patients. After the program implementation, there were significantly declined in the dyspneic scale, acute exacerbation rate, re-admission and cost of treatment (p \< 0.0001). The thirty meters increment of six-minute walk distance and minimal clinical important difference (MCID) were improved, compared to pre-implementation period (54.69, 43.75 respectively). Conclusion: The implementation of comprehensive management program in COPD patients resulted in significant improvement of the dyspneic scale, acute exacerbation rate, re-admission and cost-saving in hospital.
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Thai Journal of Tuberculosis Chest Diseases and Critical Care; Vol.30 No.2 April-June 2009; 100-111