Identification of non compliant patients and their characteristics from home oxygen data
Citation: American Journal of Respiratory and Critical Care Medicine, May 2010, vol./is. 181/1 MeetingAbstracts, 1073-449X (01 May 2010)
Abstract: The Home Oxygen Service (HOS) caters to 90,000 people in England and Wales. Since 2008, Air Products plc, principal supplier of oxygen, has been providing information on concordance to Primary Care Trusts and Local Health Boards with a concordance report issued every quarter. This identifies patients whose actual oxygen usage differs significantly from their ordered usage and gives useful information on various aspects of their therapy. Aims: Identify oxygen prescribing patterns of patients non compliant with therapy Methods: We analyzed the quarterly report generated between November 2008 and February 2009 and focused on non compliant patients with a variance in oxygen usage of more than 30%. Patient demographics comprising age, sex and primary diagnoses were collected and prescribers identified. Patients were divided into over and under users and their oxygen usage data was studied in more detail to identify patterns. Results: A total of 240 patients were using oxygen of various modalities in our area. 60 (40%) non compliant patients were identified with a mean (SD) age of 75(12) years. Females=38 (63%) Nearly half had COPD (29/60) while in 19 (32%) a formal diagnosis was not documented. All of these prescriptions were from primary care. Respiratory nurse specialists (RNS) prescribed oxygen in 20(37%) patients and primary care in 30(50%) patients. Ten (16%) prescriptions were unknown. (Table presented) Conclusions: Amongst non compliant patients, a large proportion of oxygen prescriptions continue to emanate from primary care and a third of these patients do not have a formal diagnosis. Nearly all these patients are prescribed LTOT which is not only difficult to discontinue but also imposes considerable burden on healthcare resources. In our cohort, under-users were more likely to be female and SBOT users. SBOT is still being prescribed in both settings despite its lack of evidence although isolated SBOT prescriptions are almost completely confined to primary care. Comparison with patients who are compliant is needed to fully elucidate the difference between these groups. Finally, more attention to non compliant patients identified from this readily available data not only ensures cost savings but also appropriate oxygen therapy.