[Continuous domiciliary oxygen therapy in Zaragoza: a cross-sectional home study]

Lack of Medical Criteria for Long-Term Oxygen Therapy Usage According to International Guidance in Outpatients With Chronic Hypoxemia

Background

Benefits of long-term oxygen therapy (LTOT) have been observed in hypoxemic respiratory patients. Reports have shown the lack of observance among healthcare professionals of LTOT. Thus, this study aimed to determine the demographic characteristics and observance of the medical indication of LTOT according to the international guidelines.

Methodology

A cross-sectional study was conducted on patients who attended the Medical Unit in Aguascalientes, Mexico to re-evaluate the need for LTOT. Data are presented as mean ± standard deviation. Statistical analyses were performed using the chi-square test or unpaired t-tests. P-values of <0.05 were considered statistically significant.

Results

From 813 outpatients attended to re-evaluate whether they met the medical criteria to use LTOT, 93 outpatients were excluded, and the remaining 714 outpatients were enrolled. The mean age of the patients was 70.0 ± 15.1 years, with a female gender predominance (59.1 %). The mean PaO₂ level in room air was 7.9 ± 2.3 kPa. Hemoglobin and hematocrit levels were 14.9 ± 4.1 g/dL and 44.7 ± 8.4%, respectively. The mean levels of PaO₂ were higher in female patients (8.1 ± 2.5 kPa vs. 7.6 ± 1.9 kPa; p = 0.01). The most common diagnosis was chronic obstructive pulmonary disorder (60.5%). Moreover, the specialty that most indicated the use of LTOT was pulmonology (57.8%); however, 36.8% of patients who used LTOT did not have any criteria according to international guidelines.

Conclusions

Although a significant percentage of patients do not use LTOT correctly, the most important finding is that the medical indication of LTOT by physicians is not always correct, leading to an excessive prescription of oxygen.

The importance of knowing the home conditions of patients receiving long-term oxygen therapy

Purpose

Long-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients.

Methods

Ninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively.

Results

Seventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients’ mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5–16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities.

Conclusion

The home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method.

[Quality of initial prescription of home oxygen therapy in a healthcare area of the Murcia Region (Spain)]

OBJECTIVE

To analyse the quality of the prescription of home oxygen therapy (OT) in a health area of Murcia.

METHODS

A prospective study of 125 patients in a respiratory therapy clinic, evaluated with a questionnaire and blood-gas analysis while breathing ambient air. Related respiratory therapy was also assessedin COPD and asthma patients.

RESULTS

We studied 125 cases in the 3 months following the prescription of home oxygen therapy in 72 men (58%) and 53 women (42%) with a mean age of 77.2 ± 11.6. The most common type of home OT prescribed was for palliative cases in 45 patients (36%), followed by COPD in 42 (33.6%). In 88 (92%) of the 96 medical reports that we evaluated, insufficient data as to how to administer oxygen were available. Twenty-five percent of home OT prescriptions were given without blood-gas analyses, and in the 65 cases with a blood-gas analysis only 11 (17%) met oxygen value criteria for home OT as per regulations. Oxygen desaturation was not present in 31% of the palliative care home OT cases. The analysis of blood-gases during the clinic visit in non-palliative care cases demonstrated that 61% did not meet the blood-gas criteria to continue on home OT. Eighty percent of COPD and asthma patients on home OT did not receive the correct respiratory therapy.

CONCLUSIONS

Quality problems in the prescription of home OT exist in our area. Palliative care is the principal reason for home OT prescriptions. In COPD and asthma patients who receive home OT, related respiratory therapy is not ideal.

[High prevalence of long-term domiciliary oxygen therapy with a low percentage of inappropriate prescription in the Madrid health care area. Evaluation of the correct use]

The efficacy of long-term domiciliary oxygen therapy (DOT) has been confirmed in patients who comply with guidelines; however, the prevalence in different populations varies greatly although no satisfactory explanation has been found for this.

OBJECTIVES

To assess the prevalence of inappropriate use of DOT in the health care area of the Community of Madrid, where demographic and health care features are well-defined.

MATERIAL AND METHODS

Descriptive, transversal population study enrolling all patients with DOT in our health care area over a period of one year (May 1995 to Mayo 1995). Inappropriate use was defined as characterized by at least one of the following conditions: inappropriate prescription, poor compliance or continued smoking.

RESULTS

The total number of patients was 860, the prevalence of DOT use being 178.3 per 100,000 inhabitants for the period. Ninety-three refused to participate. Nearly half the patients ha been using oxygen therapy for over two years. Seventy percent were followed by pneumologists. Seventy-four percent were men, with a mean age of 70 +/- 9 yr. Criteria for prescription were not followed in 9.7% of the cases. Chronic obstructive pulmonary disease was the reason for prescribing DOT in 59.7%. Use was appropriate in 719 cases. Use was inappropriate in 337 (46.9%), related to poor compliance in 60.5%, current smoking in 11%, and inappropriate prescription in 5.6% and for more than one criterion in 22.8%.

CONCLUSIONS

The prevalence of DOT use in our health care area is very high. The percentage of inappropriate use is high, although similar to that of other populations, and highly related to poor compliance. The percentage of inappropriate prescription is low. Possible reasons for the high prevalence are discussed.