Use and utility of a 24-hour Telephone Support Service for 'high risk' patients with COPD

Hospitalisations are important events in COPD, and exacerbation prevention strategies are not completely effective. Experience with our research cohort suggested that availability of 24-hour telephone advice may reduce hospital admission.

To examine the use and utility of a 24-hour Telephone Support Service for high-risk NHS COPD patients.

74 patients with 'high-risk' COPD had therapy optimised, were educated about exacerbations, given home 'emergency' therapy, and had 24-hour access to telephone advice.

Patients had a mean (SD) age of 70.4 (9.1) years and severe disease (mean FEV1 1.00 (0.37) litre; 30% had home oxygen and 46% lived alone). There were 258 telephone calls in 22,074 follow-up days. 76% of calls were received between 0800 and 1700 hours. The proportion of possible exacerbation ('appropriate') calls (overall 56%) was higher at weekends and overnight. Overnight calls (2100- 0800) were rare: to expect one appropriate call per shift would require 2453 patients. A third of appropriate overnight calls could be managed without further emergency assessment. Mean (SD) length of follow-up was 298 (117) days/patient. Patients completing one year of follow-up (n=52) demonstrated a 45% reduction in admissions and 37% reduction in bed days. Patient satisfaction was high.

We report data on the use and utility of a 24-hour Telephone Support Service in COPD. The service was associated with a reduction in hospital admission. Call volume was low, thus giving information on the size and cost-effectiveness of such service provision.