title: The effect of a respiratory home nurse intervention in patients with chronic obstructive pulmonary disease (COPD).
abstract: BACKGROUND
  Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD.
  
  
  OBJECTIVE
  To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD.
  
  
  METHODS
  Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co-operative Quality of Life questionnaire.
  
  
  RESULTS
  There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow-up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change.
  
  
  CONCLUSIONS
  An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.
authors.affiliation: Department of Medicine, University of Adelaide, SA. BSMITH@tqehsmtp.tqeh.sa.gov.au
authors.forename: B J
authors.initials: BJ
authors.lastname: Smith
authors.forename: S L
authors.initials: SL
authors.lastname: Appleton
authors.forename: P W
authors.initials: PW
authors.lastname: Bennett
authors.forename: G C
authors.initials: GC
authors.lastname: Roberts
authors.forename: P
authors.initials: P
authors.lastname: Del Fante
authors.forename: R
authors.initials: R
authors.lastname: Adams
authors.forename: C M
authors.initials: CM
authors.lastname: Trott
authors.forename: D P
authors.initials: DP
authors.lastname: Allan
authors.forename: A M
authors.initials: AM
authors.lastname: Southcott
authors.forename: R E
authors.initials: RE
authors.lastname: Ruffin
mesh_terms: D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality / Q000451:nursing*; D008297:Male; D011788:Quality of Life; D015656:Respiratory Mechanics