Primary care management of chronic obstructive pulmonary disease: An integrated goal-directed approach
Division of Pulmonary and Critical Care Medicine, The Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA. Current opinion in pulmonary medicine
(Impact Factor: 2.76).
12/2009; 16(2):83-8. DOI: 10.1097/MCP.0b013e3283354981
This review discusses the role of the primary care physician in the care of the patient with chronic obstructive pulmonary disease and considers how an integrated chronic care model can be applied.
Evidence suggests that a multidisciplinary approach can be successfully applied to a chronic obstructive pulmonary disease patient. These interventions can lead to improvement in quality of life and reduced healthcare utilization.
An integrated care program for chronic obstructive pulmonary disease to assist the primary care provider should include the elements of the chronic care model. The support of a community-based outreach nurse, allied health staff, rehabilitation services and a case manager can assure best practices and identify gaps in quality care.
Available from: Guangqiao Zeng
- "Since COPD is not fully reversible and recurrent exacerbations may expedite decline in lung function, the major goals of clinical treatment, as proposed by Global Strategy for the Diagnosis , Management, and Prevention of COPD (GOLD) , are to improve overall health, increase exercise tolerance and reduce frequency of COPD exacerbations in the patients . In many countries, post-hospital continuing care in the community for stable COPD patients has become an important step towards achieving these goals  , shown to have improved the disease severity and increased patient satisfaction for care-giving services  . However, Hood et al. noted that community workers faced difficulties in providing high-quality services and home follow-up visits . "
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ABSTRACT: Objective: This study explored a community nursing service mode in which respiratory nurse specialists cared for patients with chronic obstructive pulmonary disease (COPD) in a 12-week period after hospital discharge, with the aim of better preventing acute exacerbations, improving health-related quality of life (HRQOL) and reducing medical expenses in these patients. Methods: We carried out a prospective randomized controlled study in which 68 COPD patients discharged were recruited from a general hospital in Guangzhou, China, were randomized divided into two groups. The control group underwent conventional nursing care, and the intervention group received community continuing care by respiratory nurse specialists. The observation period was 12 weeks. The results of intervention were evaluated using the Seattle Obstructive Lung Disease Questionnaire (SOLDQ) and the COPD Self-Efficacy Scale (CSES). In addition, the frequency of acute exacerbations, emergency treatments or hospitalizations , and medical expenses were recorded in the 12-week observation period. Results: After six weeks, the total and subscale scores (P < 0.05) of SOLDQ and CSES significantly improved compared to the baseline ones in the intervention group. The control group had significantly higher scores in the treatment satisfaction (TS) of SOLDQ, the total score, and the weather/environment and behavioral risk factors of CSES. After 12 weeks, the total and subscale scores of SOLDQ and CSES showed a sustained and significant growth in the intervention group (P < 0.05). The control group had significantly higher scores only in the weather/environment risk factor of CSES. During the 12-week observation, the intervention group had significantly fewer acute exacerbations, emergency treatments or re-hospitalizations and significantly lower average medical expenses than the control group (P < 0.05). Conclusions: Community continuing care by respiratory nurse specialists may improve HRQOL, increase self-efficacy, reduce incidence of acute exacerbation, and lower medical expenses in patients with COPD after hospital discharge.
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ABSTRACT: Advances in the theory of robust control have brought forth two
methodologies for controller design: l<sub>1</sub> and H<sub>∞
</sub>. In this paper the authors take the approach of using examples to
illustrate some tradeoffs while designing controllers using either of
the two methodologies. Further, for the sake of simplicity the authors
consider the case of minimization of the sensitivity transfer function
in all the examples. First, the authors discuss the frequency domain
properties of l<sub>1</sub> optimal solutions and compare them with H
<sub>∞</sub> optimal solutions. Next the authors contrast l<sub>1
</sub> and H<sub>∞</sub> optimal solutions and explore their
extreme behavior. Finally with the help of an example the authors
illustrate some interesting properties of mixed minimization
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ABSTRACT: During the last decades progress has been made in the treatment of Chronic Obstructive Pulmonary Disease (COPD). We compared a random sample of patients admitted for an exacerbation in the period 2001-2005 (n = 101), with a random sample of patients hospitalized for the same reason in the period 1980-1984 (n = 51). Patients of the 2001-2005 cohort had a lower FEV1 (48 ± 3 vs. 41 ± 2% predicted, p = 0.01) for similar mean age, gender and body- mass index when compared to the historical sample. Co-morbidities, according to the Charlson's index, were more prevalent in the 2001-2005 cohort compared to the 1980-1984 cohort, with a reduction of hemoglobin (13.9 ± 0.2 gr/dl vs. 14.9 ± 0.2, p < 0.01) and higher prevalence of anemia in the most recent cohort. We found an increase in the use of cardiovascular drugs and respiratory medications over time with exception for the long-term use of oxygen. Despite lower FEV1 and more prevalent co-morbidities, no difference in length of hospitalization (13.6 ± 1.4 days vs. 12.7 ± 0.7 days, p = 0.52) and 30 months survival post-exacerbation was noted (66.6% vs. 69.3%, p = 0.85). Over the course of 20 years, the presentation of COPD patients admitted for an exacerbation seems to be changed towards a more severe phenotype with lower FEV1 and more co-morbidities. As the length of hospitalization and the overall survival were not different between the two samples, a currently improved management of COPD can be hypothesized.
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