Use and utility of a 24-hour Telephone Support Service for 'high risk' patients with COPD.
BACKGROUND
Hospitalisations are important events in COPD, and exacerbation prevention strategies are not completely effective. Experience with our research cohort suggested that availability of 24-hour telephone advice may reduce hospital admission.


OBJECTIVE
To examine the use and utility of a 24-hour Telephone Support Service for high-risk NHS COPD patients.


METHODS
74 patients with 'high-risk' COPD had therapy optimised, were educated about exacerbations, given home 'emergency' therapy, and had 24-hour access to telephone advice.


RESULTS
Patients had a mean (SD) age of 70.4 (9.1) years and severe disease (mean FEV1 1.00 (0.37) litre; 30% had home oxygen and 46% lived alone). There were 258 telephone calls in 22,074 follow-up days. 76% of calls were received between 0800 and 1700 hours. The proportion of possible exacerbation ('appropriate') calls (overall 56%) was higher at weekends and overnight. Overnight calls (2100- 0800) were rare: to expect one appropriate call per shift would require 2453 patients. A third of appropriate overnight calls could be managed without further emergency assessment. Mean (SD) length of follow-up was 298 (117) days/patient. Patients completing one year of follow-up (n=52) demonstrated a 45% reduction in admissions and 37% reduction in bed days. Patient satisfaction was high.


CONCLUSIONS
We report data on the use and utility of a 24-hour Telephone Support Service in COPD. The service was associated with a reduction in hospital admission. Call volume was low, thus giving information on the size and cost-effectiveness of such service provision.
Hurst
John R
JR
Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, London, UK. j.hurst@medsch.ucl.ac.uk
Fitzgerald-Khan
Fiona
F
Quint
Jennifer K
JK
Goldring
James Jp
JJ
Mikelsons
Christine
C
Dilworth
J Paul
JP
Wedzicha
Jadwiga A
JA
D000368:Aged; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D006113:United Kingdom