Sridhar M, Taylor R, Dawson S, Roberts N J, Partridge M R
NHLI Division, Faculty of Medicine, Imperial College London, Charing Cross Campus, London W6 8RP, UK.
Thorax. 2008 Mar;63(3):194-200. doi: 10.1136/thx.2007.077578. Epub 2007 Sep 27.
To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Randomised controlled trial.
Community and hospital care in west London.
122 patients with COPD.
A care package incorporating initial pulmonary rehabilitation and self-management education, provision of a written, personalised COPD action plan, monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years.
Hospital readmission rate.
Unscheduled primary care consultations and quality of life.
There were no differences in hospital admission rates or in exacerbation rates between the two groups. Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics, and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves. 12 patients in the control group died during the 2 year period, eight as a result of COPD, compared with six patients in the intervention group, of whom one died from COPD. This is a significant difference. When the numbers were adjusted to reflect the numbers still alive at 2 years, in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner (GP) and in the control group, 280 contacts. The number needed to treat was 0.558--ie, for every one COPD patient receiving the intervention and self-management advice, there were 1.79 fewer unscheduled contacts with the GP.
An intermediate care package incorporating pulmonary rehabilitation, self-management education and the receipt of a written COPD action plan, together with regular nurse contact, is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate.
确定由护士主导的中间护理计划对因慢性阻塞性肺疾病急性加重（AECOPD）而住院的患者的影响。
随机对照试验。
伦敦西部的社区和医院护理机构。
122例慢性阻塞性肺疾病患者。
一个护理方案，包括初始肺康复和自我管理教育、提供书面的个性化慢性阻塞性肺疾病行动计划、每月电话随访以及由专科护士每3个月进行一次家访，为期2年。
住院再入院率。
非计划的初级保健会诊次数和生活质量。
两组之间的住院率或病情加重率没有差异。病情加重的自我管理存在显著差异，干预组更有可能仅接受口服类固醇或口服类固醇和抗生素治疗，且病情加重治疗的发起者在统计学上更有可能是患者本人。对照组中有12例患者在2年期间死亡，其中8例死于慢性阻塞性肺疾病，而干预组中有6例患者死亡，其中1例死于慢性阻塞性肺疾病。这是一个显著差异。当对数据进行调整以反映2年后仍存活的人数时，干预组患者报告与他们的全科医生（GP）进行了总共171次非计划接触，而对照组为280次。治疗所需人数为0.558，即每有一名接受干预和自我管理建议的慢性阻塞性肺疾病患者，与全科医生的非计划接触就会减少1.79次。
一个包含肺康复、自我管理教育、收到书面慢性阻塞性肺疾病行动计划以及护士定期联系的中间护理方案，与减少非计划的初级保健会诊需求以及降低慢性阻塞性肺疾病导致的死亡率相关，但不影响住院再入院率。
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