Smith B, Appleton S, Adams R, Southcott A, Ruffin R
Medicine, University of Adelaide, Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, Australia.
Cochrane Database Syst Rev. 2001(3):CD000994. doi: 10.1002/14651858.CD000994.
Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and deterioration in health. It is associated with significant morbidity, mortality and costs to health care systems. Care strategies, such as outreach nursing in the community, may reduce this burden.
To evaluate the effectiveness of outreach respiratory health care worker programmes for patients with COPD in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and hospital service utilisation.
A search was carried out using the Cochrane Airways Group database. Bibliographies of identified RCTs were searched for additional relevant RCTs. Authors of identified RCTS were contacted for other published and unpublished studies.
Only randomised control trials of patients with COPD were included. The intervention was an outreach nurse visiting patients in their homes, providing support, education, monitoring patient status and providing liaison with physicians. Interventions that used nurse practitioners who provided therapeutic intervention were also included. Studies in which the therapeutic intervention under test was physical training were not included.
Data extraction and study quality assessment were performed independently by two reviewers. Where further or missing data was required, authors of studies were contacted.
Four studies were found. Three assessed mortality following twelve months of care (n=96, 152 and 301), and one after seven months(n=75). Meta-analysis demonstrated that mortality was not significantly reduced by the intervention, Peto Odds Ratio 0.72; 95 % confidence interval 0.43, 1.21. Post hoc subgroup analysis suggested that mortality was reduced by the outreach nursing programme in patients with less severe disease. Significant improvements in health related quality of life were reported in one study in moderate COPD, but not in a study in patients with severe disease. No changes in lung function or exercise performance were found in the studies where data were available. Hospital admissions were reported in only one study in patients with severe disease and no benefit was observed. A further search was conducted in July 2000 did not yield any more studies for inclusion.
REVIEWER'S CONCLUSIONS: Patients with moderate COPD may have mortality and health related quality of life gains from a nursing outreach programme, but there are no data about reductions in hospital utilisation. Patients with severe COPD do not appear to have benefit from such programmes and one large study found no reduction in hospital admissions in such patients.
慢性阻塞性肺疾病（COPD）的特征是气流进行性阻塞、运动能力恶化和健康状况下降。它与较高的发病率、死亡率以及医疗保健系统的成本相关。诸如社区外展护理等护理策略可能会减轻这种负担。
评估外展呼吸健康护理工作者项目对慢性阻塞性肺疾病患者的有效性，包括改善患者及其护理者的肺功能、运动耐量和健康相关生活质量（HRQL），以及降低死亡率和医院服务利用率。
使用Cochrane Airways Group数据库进行检索。对已识别的随机对照试验的参考文献进行检索以查找其他相关随机对照试验。联系已识别的随机对照试验的作者以获取其他已发表和未发表的研究。
仅纳入慢性阻塞性肺疾病患者的随机对照试验。干预措施是外展护士到患者家中探访，提供支持、教育、监测患者状况并与医生进行联络。使用提供治疗干预的执业护士的干预措施也包括在内。正在测试的治疗干预为体育锻炼的研究不包括在内。
由两名评审员独立进行数据提取和研究质量评估。如需更多数据或缺失数据，会联系研究的作者。
共找到四项研究。三项评估了十二个月护理后的死亡率（n分别为96、152和301），一项评估了七个月后的死亡率（n = 75）。荟萃分析表明，干预措施并未显著降低死亡率，Peto比值比为0.72；95%置信区间为0.43至1.21。事后亚组分析表明，病情较轻的患者通过外展护理项目死亡率降低。一项针对中度慢性阻塞性肺疾病患者的研究报告称健康相关生活质量有显著改善，但针对重度疾病患者的一项研究则未发现。在有数据的研究中未发现肺功能或运动表现有变化。仅一项针对重度疾病患者的研究报告了住院情况，未观察到任何益处。2000年7月进行的进一步检索未找到更多可纳入的研究。
中度慢性阻塞性肺疾病患者可能从护理外展项目中获得死亡率降低和健康相关生活质量改善，但尚无关于医院利用率降低的数据。重度慢性阻塞性肺疾病患者似乎未从此类项目中获益，一项大型研究发现此类患者的住院率未降低。
