Coordination of primary health care and hospital care reduces readmission in COPD

July 06, 2006

Readmission of patients with chronic obstructive pulmonary disease (COPD) is a major problem within health systems. Each admission for exacerbation worsens the patient's quality of life and, at the same time, presents an economic challenge for the hospital centre. A study published in the European Respiratory Journal describes the usefulness of an integrated and coordinated intervention of primary health care and hospital health care. This work, which demonstrates the benefits of cooperation among several health care levels, has been led by Dr. Josep Roca and Mrs. Carme Hernàndez, members of the IDIBAPS Physiopathological Mechanisms of the Respiratory Disease Group and of the Pneumology Unit of Hospital Clínic.

This study includes 150 patients, 65 of which receive integrated health care. Results show that more than a half of these patients do not need readmission, whereas 67% of patients receiving conventional health care are readmitted in hospital. Previous studies assessing home health care did not obtain conclusive results. The main limitations were the lack of standardisation of the interventions and the lack of homogeneity of patients. In this new work, highly precise criteria for the inclusion of patients have been defined, and intervention protocols have been highly detailed. Protocols were not identical in both countries participating in the study, what reinforces the positive results obtained. Differences among both countries have permitted to conclude that a higher number of home health care appointments does not imply better results on the health of patients. The Belgian system implied more home care assistance than the Catalan system, but no differences were observed in the results. This works is presented as a conclusion of the European project CHRONIC, a pioneer European telemedicine research project started on January 2000 that closes with this publication.

The design of integrated health care of these initiatives makes health specialists much more accessible to patients, primarily thanks to an only telephonic switchboard for these patients. Furthermore, COPD patients receive an informative course on their disease, which gives them more autonomy. Results of this study are along the same line of those obtained with the Home Care Programme promoted by Hospital Clínic during the first trimester of 2006 aimed to patients with COPD and cardiac insufficiency. Patients included in this programme evolved from a 9-day admission to a 2-day admission. This programme, which emphasizes specialised nursing and medical cooperation, was initially supported by CATSalut, but now and until 31 December the project will be supported by Hospital Clínic. Home care health reflects the fructuous relationship between hospital care and research in Hospital Clínic, and could be a major tool of health management in several chronic diseases in the future. 60% of patients admitted in emergencies have a chronic pathology; therefore, the fact of giving assistance to these patients at the correct health care levels can be a decisive factor in third level hospitals, such as Hospital Clínic, in order not to collapse the centre.
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IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer

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