在基于医院的家庭护理环境中，患有 COPD 的老年患者比患有老年心力衰竭的患者需要更多的医疗保健。
Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting.
机构信息
Respiratory Medicine, Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden.
Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
出版信息
Int J Chron Obstruct Pulmon Dis. 2019 Jul 16;14:1569-1581. doi: 10.2147/COPD.S207621. eCollection 2019.
BACKGROUND
Elderly patients with advanced stages of COPD or chronic heart failure (CHF) often require hospitalization due to exacerbations. We hypothesized that telemonitoring supported by hospital-based home care (HBHC) would detect exacerbations early, thus, reducing the number of hospitalization. We also speculated that patients with advanced COPD or CHF would present differences regarding exacerbation frequency and the need of HBHC.
METHODS
The Health Diary system, based on digital pen technology, was employed. Patients aged ≥65 years with ≥2 hospitalizations the previous year were included. Exacerbations were categorized and treated as either COPD or CHF exacerbation by an experienced physician. All HBHC contacts (home visits or telephone consultations) were registered.
RESULTS
Ninety-four patients with advanced diseases were enrolled (36 COPD and 58 CHF subjects) of which 53 subjects (19 COPD and 34 CHF subjects) completed the 1-year study period. Death was the major reason for not finalizing the study. Compared to the 1-year prior inclusion, the intervention significantly reduced hospitalization. Although COPD subjects were younger with less comorbidity, exacerbations and HBHC contacts were significantly greater in this group.
CONCLUSIONS
COPD subjects exhibit exacerbations more frequently, mainly due to disease characteristics, thus, demanding much more HBHC.
背景
患有晚期 COPD 或慢性心力衰竭（CHF）的老年患者常因病情恶化而需要住院治疗。我们假设，通过医院家庭护理（HBHC）提供的远程监护可以及早发现病情恶化，从而减少住院次数。我们还推测，患有晚期 COPD 或 CHF 的患者在病情恶化频率和 HBHC 需求方面可能存在差异。
方法
采用基于数字笔技术的健康日记系统。纳入年龄≥65 岁且前一年有≥2 次住院史的患者。由经验丰富的医生对病情恶化进行分类，并将其归类为 COPD 或 CHF 恶化。所有 HBHC 接触（家访或电话咨询）都进行了登记。
结果
共纳入 94 例晚期疾病患者（36 例 COPD 和 58 例 CHF 患者），其中 53 例患者（19 例 COPD 和 34 例 CHF 患者）完成了 1 年的研究期。死亡是未完成研究的主要原因。与前 1 年的纳入相比，干预措施显著减少了住院次数。尽管 COPD 患者年龄较小，合并症较少，但该组患者的病情恶化和 HBHC 接触次数明显更多。
结论
COPD 患者病情恶化更为频繁，主要是由于疾病特征所致，因此需要更多的 HBHC。
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