title: Use and utility of a 24-hour Telephone Support Service for 'high risk' patients with COPD.
abstract: 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.
authors.affiliation: Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, London, UK. j.hurst@medsch.ucl.ac.uk
authors.forename: John R
authors.initials: JR
authors.lastname: Hurst
authors.forename: Fiona
authors.initials: F
authors.lastname: Fitzgerald-Khan
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Quint
authors.forename: James Jp
authors.initials: JJ
authors.lastname: Goldring
authors.forename: Christine
authors.initials: C
authors.lastname: Mikelsons
authors.forename: J Paul
authors.initials: JP
authors.lastname: Dilworth
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
mesh_terms: 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