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Thorax. 1991 August; 46(8): 559–564.
PMCID: PMC463273

Randomised controlled trial of the effectiveness of a respiratory health worker in reducing impairment, disability, and handicap due to chronic airflow limitation.

Abstract

A randomised controlled trial was undertaken to determine whether a respiratory health worker was effective in reducing the respiratory impairment, disability, and handicap experienced by patients with chronic airflow limitation attending a respiratory outpatient department. The 152 adults (aged 30-75 years) who participated had a prebronchodilator forced expiratory volume in one second (FEV1) below 60% predicted and no other disease. They were randomised to receive the care of a respiratory health worker or the normal services provided by the outpatient department. The respiratory health worker provided health education and symptom and treatment monitoring in liaison with primary care services. After one year there was little difference between the two groups in spirometric values (FEV1 and forced vital capacity before and after salbutamol 200 micrograms), disability (six minute walking distance and paced step test), and handicap (sickness impact profile, hospital anxiety and depression scale). Patients not looked after by the respiratory health worker were more likely to die (relative risk 2.9 (95% confidence limits 0.8, 10.2); when age and FEV1 were controlled for this risk increased to 5.5 (95% confidence limits 1.2, 24.5). Patients looked after by the respiratory health worker attended their general practitioner more frequently and were prescribed a greater range of drugs. This is the third study to have found limited measurable benefit in terms of morbidity from the intervention of a respiratory health worker. This may be due to the ability of such workers to keep frail patients alive.

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Selected References

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  • McCarthy M. Cutting the cake: government spending plans for 1986-9. Br Med J (Clin Res Ed) 1986 Mar 22;292(6523):840–842. [PMC free article] [PubMed]
  • Burke-Masters BM. The autonomous nurse practitioner: an answer to a chronic problem of primary care. Lancet. 1986 May 31;1(8492):1266–1266. [PubMed]
  • Cintron G, Bigas C, Linares E, Aranda JM, Hernandez E. Nurse practitioner role in a chronic congestive heart failure clinic: in-hospital time, costs, and patient satisfaction. Heart Lung. 1983 May;12(3):237–240. [PubMed]
  • Cockcroft A, Bagnall P, Heslop A, Andersson N, Heaton R, Batstone J, Allen J, Spencer P, Guz A. Controlled trial of respiratory health worker visiting patients with chronic respiratory disability. Br Med J (Clin Res Ed) 1987 Jan 24;294(6566):225–228. [PMC free article] [PubMed]
  • Bergner M, Hudson LD, Conrad DA, Patmont CM, McDonald GJ, Perrin EB, Gilson BS. The cost and efficacy of home care for patients with chronic lung disease. Med Care. 1988 Jun;26(6):566–579. [PubMed]
  • Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982 May 29;284(6329):1607–1608. [PMC free article] [PubMed]
  • Swinburn CR, Wakefield JM, Jones PW. Performance, ventilation, and oxygen consumption in three different types of exercise test in patients with chronic obstructive lung disease. Thorax. 1985 Aug;40(8):581–586. [PMC free article] [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]
  • Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. [PubMed]
  • Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J (Clin Res Ed) 1986 Mar 15;292(6522):746–750. [PMC free article] [PubMed]
  • Krzyzanowski M, Wysocki M. The relation of thirteen-year mortality to ventilatory impairment and other respiratory symptoms: the Cracow Study. Int J Epidemiol. 1986 Mar;15(1):56–64. [PubMed]
  • Jones PW, Baveystock CM, Littlejohns P. Relationships between general health measured with the sickness impact profile and respiratory symptoms, physiological measures, and mood in patients with chronic airflow limitation. Am Rev Respir Dis. 1989 Dec;140(6):1538–1543. [PubMed]
  • MacKenzie CR, Charlson ME, DiGioia D, Kelley K. Can the Sickness Impact Profile measure change? An example of scale assessment. J Chronic Dis. 1986;39(6):429–438. [PubMed]
  • Dudley DL, Glaser EM, Jorgenson BN, Logan DL. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease. Part 2. Psychosocial treatment. Chest. 1980 Apr;77(4):544–551. [PubMed]
  • Rutter BM. The prognostic significance of psychological factors in the management of chronic bronchitis. Psychol Med. 1979 Feb;9(1):63–70. [PubMed]
  • Sensky T, Dennehy M, Gilbert A, Begent R, Newlands E, Rustin G, Thompson C. Physicians' perceptions of anxiety and depression among their outpatients: relationships with patients and doctors' satisfaction with their interviews. J R Coll Physicians Lond. 1989 Jan;23(1):33–38. [PubMed]

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