D1.3 GP practice nurse/ nurse practitioner/ respiratory educator/ respiratory nurse

Specific aspects of care provided by these health professionals in COPD may include:

  • respiratory assessment, including spirometry and pulse oximetry;
  • implementation of, or referral for interventions such as exercise training, pulmonary rehabilitation, smoking cessation, airway clearance techniques and oxygen therapy;
  • skills training with inhalation devices;
  • education to promote better self-management (eg, medi­cations and response to worsening of symptoms);
  • organisation of multidisciplinary case conferences and participation in care-plan development; and
  • assessment of the home environment.

Patients discharged from a Hong Kong hospital after a COPD exacerbation were randomised to an intervention group (IG) or usual care group (UG). The IG received a comprehensive, individualised care plan which included education from a respiratory nurse, physiotherapist support for pulmonary rehabilitation, three-monthly telephone calls by a respiratory nurse over one year, and follow-up at a respiratory clinic with a respiratory specialist once every three months for one year. The UG was managed according to standard practice. At 12 months, the adjusted relative risk of readmission was 0.668 (95% CI 0.449 to 0.995, p=0.047) for the IG compared with the UG. At 12 months, the IG had a shorter length of stay (4.59±7.16 vs 8.86±10.24 days, p≤0.001), greater improvement in mean Modified Medical Research Council Dyspnoea Scale (-0.1±0.6 vs. 0.2±0.6, p=0.003) and St George’s Respiratory Questionnaire score (-6.9±15.3 vs -0.1±13.8, p=0.003) compared with the UG (Ko 2017).