Uptake of Clinical Prognostic Tools in COPD Exacerbations Requiring Hospitalisation

COPD. 2021 Aug 6:1-5. doi: 10.1080/15412555.2021.1959540. Online ahead of print.ABSTRACTClinical prognostic tools are used to objectively predict outcomes in many fields of medicine. Whilst over 400 have been developed for use in chronic obstructive pulmonary disease (COPD), only a minority have undergone full external validation and just one, the DECAF score, has undergone an implementation study supporting use in clinical practice. Little is known about how such tools are used in the UK. We distributed surveys at two time points, in 2017 and 2019, to hospitals included in the Royal College of Physicians of London national COPD secondary care audit program. The survey assessed the use of prognostic tools in routine care of hospitalized COPD patients. Hospital response rates were 71/196 in 2017 and 72/196 in 2019. The use of the DECAF and PEARL scores more than doubled in decisions about unsupported discharge (7%-15.3%), admission avoidance (8.1%-17%) and readmission avoidance (4.8%-13.1%); it more than tripled (8.8%-27.8%) in decisions around hospital-at-home or early supported discharge schemes. In other areas, routine use of clinical prognostic tools was uncommon. In palliative care decisions, the use of the Gold Standards Framework Prognostic Indicator Guidance fell (5.6%-1.4%). In 2017, 43.7% of hospitals used at least one clinical prognostic tool in routine COPD care, increasing to 52.1% in 2019. Such tools can help challenge prognostic pessimism and improve care. To in...
Source: COPD: Journal of Chronic Obstructive Pulmonary Disease - Category: Respiratory Medicine Authors: Source Type: research

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Conclusion Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced nonmalignant respiratory illnesses.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Review Source Type: research
The number of people over the age of 65 years living with chronic diseases is exponentially rising worldwide. In 2008, the World Health Organization estimated physicians diagnosed approximately 210 million people worldwide with COPD and millions of others with another respiratory disease (e.g. asthma or interstitial lung disease) [1]. Many among these millions of patients with advanced, chronic non-malignant respiratory diseases often experience disabling (intractable) dyspnoea, cough and pain. Dyspnoea (breathlessness) is an "air hunger" comprising a multifaceted, subjective symptom with significant impact ...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research
J Soc Work End Life Palliat Care. 2021 Oct 3:1-16. doi: 10.1080/15524256.2021.1976353. Online ahead of print.ABSTRACTHealth care professionals working with older people living alone with chronic obstructive pulmonary disease (COPD) to complete advance care planning (ACP) often encounter the double burden of social isolation and acute exacerbations in this planning. The study explored clinicians' perceptions regarding factors influencing the completion of ACP for older people with COPD living alone. Individual interviews were conducted with 18 health care professionals using the video meeting platform in 2020. A semi-struct...
Source: Journal of Social Work in End-of-Life and Palliative Care - Category: Palliative Care Authors: Source Type: research
Aust Health Rev. 2021 Sep 16. doi: 10.1071/AH21052. Online ahead of print.ABSTRACTObjectiveThe aim of this study was to assess the unmet need for palliative and other end-of-life care, as well as the sociodemographic and diagnostic factors associated with suboptimal access, among residents in an Australian region.MethodsA cross-sectional descriptive and analytical study was performed using non-identifiable linked data from four administrative and two clinical datasets. The study population comprised 3175 patients aged ≥15 years who died in hospital in 2016 and 2017. The main outcome measures were the proportion of deced...
Source: Australian Health Review - Category: Hospital Management Authors: Source Type: research
Aust J Rural Health. 2021 Sep 13. doi: 10.1111/ajr.12782. Online ahead of print.ABSTRACTOBJECTIVE: To evaluate the utility and outcomes for Indigenous and non-Indigenous patients requiring domiciliary oxygen therapy.DESIGN: Retrospective study.SETTING: Patients residing in the regional and rural Top End Health Service region of the Northern Territory of Australia.PARTICIPANTS: Indigenous and non-Indigenous patients prescribed domiciliary oxygen therapy between 2018 and 2020.INTERVENTIONS: Demographics and clinical indication for domiciliary oxygen therapy and mortality were analysed.MAIN OUTCOME MEASURES: Differences betwe...
Source: Rural Remote Health - Category: Rural Health Authors: Source Type: research
This study explored knowledge, attitudes, and practice regarding ACP for patients with COPD among Australian and New Zealand respiratory nurses. A cross-sectional online survey tested knowledge about ACP and canvassed attitudes about current practice. Data were analyzed using descriptive statistics and content analysis of text data. The 112 participating respiratory nurses had substantial knowledge and positive attitudes regarding ACP in COPD; however, they lacked confidence and clarity regarding their role. Despite advances in end-of-life care provision for chronic disease, well-established barriers remained (inadequate t...
Source: Journal of Hospice and Palliative Nursing - Category: Nursing Tags: Feature Articles Source Type: research
Condition:   COPD Intervention:   Behavioral: ENABLE-COPD Sponsor:   University of Alabama at Birmingham Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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