Extrait

Background and study aims Chronic Obstructive Pulmonary Disease (COPD) is a common lung disease in which patients develop progressive breathlessness, cough and phlegm. Such patients suffer episodes when their symptoms increase, often triggered by infection, called acute exacerbations (AECOPD). AECOPD are the second most common reason for all hospital admissions. There are potential clinical and financial benefits in managing patients at home during exacerbations. Hospital staff with experience of treating unwell patients can deliver most treatments at home that are provided in hospital. It is recommended that patient selection for Hospital at Home (HAH) be based on chance of survival, whilst recognising the lack of a tool for prediction at the time the guideline was written. We then developed a novel, simple clinical scoring system (DECAF) that can predict the survival of patients hospitalised with AECOPD. In this study we aim to find out whether HAH is safe and more cost-effective than hospital admission, whether HAH is the preferred choice for patients and carers, and whether HAH is associated with improvements in health-related quality of life. Who can participate? Adults aged 35 or over who are admitted to one of the participating hospitals with an acute exacerbation of COPD and assessed as low risk by the DECAF score can participate. For the qualitative study, patient's carers and healthcare professionals directly involved with caring for patients in the study will be eligible for interview. What does the study involve? After obtaining consent, patients will be randomly allocated to be treated for their exacerbation either in the usual way, which involves hospital admission, or to be treated at home. The medical treatment for those patients at home will largely be the same as for those patients in hospital. We will collect clinical information from patients, including their preferred treatment and their health-related quality of life. The costs of the treatment and the costs of social care (including the family carer) will be collected for the economic analysis. This information will be collected from admission up to 90 days. Patients, their carers and healthcare professionals will be approached for interview. What are the possible benefits and risks of participating? HAH may foster independence, help maintain usual activities and avoid the complications associated with hospital admission. We do not foresee any risks from participation. Previous studies have shown that home treatment for acute exacerbations of COPD is safe. Where is the study run from? 1. North Tyneside General Hospital (UK) 2. Wansbeck General Hospital, Ashington (UK) 3. Northumbria Specialist Emergency Care Hospital (UK) When is the study starting and how long is it expected to run for? The study started at the end of April 2014 and participants will be recruited over 20 months and followed up for 90 days. Who is funding the study? National Institute for Health Research (NIHR), UK. Who is the main contact? Carlos Echevarria [email protected]

Critère d'inclusion

• Chronic Obstructive Pulmonary Disease

Liens

• ictrp
• isrctn