Pulmonary, Critical Care, and Sleep Medicine, West Virginia University, Morgantown, WV, USA.
Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA.
Clin Respir J. 2021 Jul;15(7):728-734. doi: 10.1111/crj.13354. Epub 2021 Mar 18.
Rural regions have unique challenges with the implementation of new therapies upon discharge from the hospital due to multiple barriers.
We investigated the effect of home non-invasive ventilation (NIV) plus the implementation of a call center following hospitalization for acute exacerbations of COPD (chronic obstructive lung disease) on NIV usage and readmissions.
In this prospective pilot study, consecutive patients were screened at our institution for diagnosis of hypercarbic respiratory failure or COPD exacerbation from 2018 to 2019. Patients with more than two admissions in the last year were reviewed for eligibility. Of the 82 patients screened, 22 were eligible. There were 10 participants randomized to the intervention (NIV and call center) arm and 10 to NIV alone.
A total of 20 patients were randomized (mean age of 64, 45% males, BMI of 32). At three months, average usage was 32.1 days out of 90, 35%. When comparing the call center group to the standard group, there was a statistically significant difference in total days of device usage 48.7 compared to 15.5 (significant U-value of 16, critical value of U at p<.05 of 27) and cumulative use in hours 284 versus 87.7 (significant U-value of 20). Participants in the call center group were readmitted on average 4.2 times compared to 2.4 in the control group which was not statistically different (non-significant U-value of 42). In the follow-up period, 9/20 (45%) of the participants died.
This pilot study highlights the challenges in implementing care for advanced COPD in a rural population. Our data suggest that telemedicine may favorably address therapy adherence.
由于多种障碍，农村地区在出院后实施新疗法方面存在独特的挑战。
我们研究了急性加重期 COPD（慢性阻塞性肺疾病）患者出院后家庭无创通气（NIV）加呼叫中心的实施对 NIV 使用和再入院的影响。
在这项前瞻性试点研究中，我们机构从 2018 年到 2019 年连续筛选出患有高碳酸血症性呼吸衰竭或 COPD 加重的患者。对过去一年有两次以上入院的患者进行了资格审查。在 82 名筛查患者中，有 22 名符合条件。其中 10 名患者被随机分为干预（NIV 和呼叫中心）组，10 名患者单独接受 NIV 治疗。
共有 20 名患者被随机分组（平均年龄 64 岁，45%为男性，BMI 为 32）。在三个月时，平均使用时间为 90 天中的 32.1 天，使用率为 35%。与标准组相比，呼叫中心组的设备总使用天数有统计学显著差异，分别为 48.7 天和 15.5 天（U 值为 16，p<.05 的 U 值临界值为 27），累计使用小时数分别为 284 小时和 87.7 小时（U 值为 20）。呼叫中心组的患者平均再入院 4.2 次，而对照组为 2.4 次，但差异无统计学意义（U 值为 42）。在随访期间，20 名参与者中有 9 名（45%）死亡。
本试点研究强调了在农村地区为晚期 COPD 患者实施护理的挑战。我们的数据表明，远程医疗可能有利于解决治疗依从性问题。
