title: Evaluation of oxygen prescription in relation to hospital admission rate in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Long term oxygen therapy (LTOT) has a strong evidence base in COPD patients with respiratory failure, but prescribing practices are recognized to need reform to ensure appropriate use and minimize costs. In the UK, since February 2006, all Home Oxygen prescription is issued by hospitals, making respiratory specialists totally in charge of home oxygen prescription. It has been widely noted that inappropriate home oxygen, often for intermittent use ("short burst"), is frequently prescribed in patients with COPD and related conditions with the intention to prevent hospital admissions outside of evidence based LTOT guidelines. We participated in a national Lung Improvement Project aimed at making LTOT use more evidence based. We utilised this unique opportunity of studying the effect of removal of oxygen from COPD patients (who did not meet LTOT criteria) on hospital admission rates.
  
  
  METHODS
  Primary and secondary care data sources were used to identify patients with COPD in a single primary care trust who were admitted to hospital at least once due to COPD between April 2007 and November 2010. Admission rates were compared between LTOT users and non-users, adjusted for age and COPD severity. LTOT users were further studied for predictors of admission in those appropriately or inappropriately given oxygen according to NICE guidance, and for admissions before and after oxygen receipt, adjusting further for co-morbidity. Mortality and economic analyses were also conducted.
  
  
  RESULTS
  Readmission was more likely in LTOT users (3.18 v 1.67 per patient, p<0.001) after adjustment for FEV1 and age by multiple regression. When stratifying by appropriateness of LTOT prescription, adjusting also for Charlson index and other covariates, FEV1 predicted admission in appropriate users but there were no predictors in inappropriate users. In longitudinal analyses admission rates did not differ either side of oxygen prescription in appropriate or inappropriate LTOT users. Specialist assessment resulted in cost savings due to reduced use of oxygen.
  
  
  CONCLUSIONS
  Admission to hospital is more likely in LTOT users, independent of COPD severity. Oxygen use outside NICE guidance does not appear to prevent admissions.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Turner
authors.forename: Sourav
authors.initials: S
authors.lastname: Sen
authors.forename: Cathryn
authors.initials: C
authors.lastname: Steeley
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Khan
authors.forename: Pamela
authors.initials: P
authors.lastname: Sweeney
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Richards
authors.affiliation: Department of Respiratory Medicine & Physiology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, UK. rmukherjee@doctors.net.uk.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mukherjee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D005260:Female; D005541:Forced Expiratory Volume; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D006113:United Kingdom; D028761:Withholding Treatment / Q000191:economics / Q000706:statistics & numerical data*
references.citation: Chron Respir Dis. 2005;2(2):107-8
references.pmid: 16279158
references.citation: Respir Care. 2011 Nov;56(11):1812-7
references.pmid: 21605486
references.citation: J Clin Epidemiol. 2003 Mar;56(3):221-9
references.pmid: 12725876
references.citation: Thorax. 2008 Jun;63(6):566
references.pmid: 18511644
references.citation: Drugs Aging. 2011 Dec 1;28(12):1007-14
references.pmid: 22117098
references.citation: Am J Manag Care. 2009 Feb;15(2):97-104
references.pmid: 19284806
references.citation: Lancet. 1981 Mar 28;1(8222):681-6
references.pmid: 6110912
references.citation: J R Coll Physicians Lond. 1999 Sep-Oct;33(5):445-7
references.pmid: 10624659
references.citation: BMC Pulm Med. 2011 Nov 04;11:49
references.pmid: 22054636
references.citation: N Engl J Med. 2004 Mar 4;350(10):1005-12
references.pmid: 14999112
references.citation: Cochrane Database Syst Rev. 2011 Jun 15;(6):CD006429
references.pmid: 21678356
references.citation: Chest. 2008 Oct;134(4):746-752
references.pmid: 18625667
references.citation: Am Rev Respir Dis. 1985 Apr;131(4):493-8
references.pmid: 3922267
references.citation: BMJ. 1999 Jul 3;319(7201):19-23
references.pmid: 10390453
references.citation: Ann Intern Med. 1980 Sep;93(3):391-8
references.pmid: 6776858
references.citation: Nurs Times. 2011 Oct 25-31;107(42):24-5
references.pmid: 22187826
references.citation: Can Respir J. 2009 Jul-Aug;16(4):e43-9
references.pmid: 19707601
references.citation: N Engl J Med. 2010 Sep 16;363(12):1128-38
references.pmid: 20843247
references.citation: Eur Respir J. 2002 Aug;20(2):306-12
references.pmid: 12212960
references.citation: Respir Care. 2008 Sep;53(9):1169-75
references.pmid: 18718034
references.citation: Thorax. 2006 Sep;61(9):830
references.pmid: 16936240
references.citation: Respir Med. 2011 Feb;105(2):266-73
references.pmid: 20655186
references.citation: Eur Respir J. 1998 Dec;12(6):1284-9
references.pmid: 9877478
references.citation: Respir Med. 2006 Jul;100(7):1129-38
references.pmid: 16737805
references.citation: Chest. 2010 Jul;138(1):179-87
references.pmid: 20605816
references.citation: Clin Respir J. 2012 Apr;6(2):72-80
references.pmid: 21812941