Outcomes of Management Program in Complex COPD Patients in Tha Wang Pha Hospital, Nan Province

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จุฬาลักษณ์ โรจนวิภาต


Background: Chronic obstructive pulmonary disease (COPD) is the important cause of hospitalization and consumes high cost of treatment. Clinical practice guideline had been introduced in Tha Wang Pha Hospital since 2011, but acute exacerbation still frequently occurred. The more appropriate management program was implemented by concept adaptation from Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline).
Objective: To evaluate the treatment outcomes before and after implementing the management program in complex COPD patients.                                              Material and method: The quasi-experimental research, one-group pretest and posttest design, was conducted in 31 COPD patients who had >2 emergency room visits or >1 hospitalization for acute exacerbation within the previous 6 months. All patients attended the program 4
times within 6 months. Data were collected before and after the program (July-December 2015 vs January-July 2016). Pulmonary function test, modified Medical Research Council (mMRC) dyspnea score, COPD assessment test (CAT) score, six-minute-walk distance and combined COPD assessment were evaluated. Data were analyzed by descriptive statistics, chi-square and paired t-test.
Results: The mean age was 67.7±8.7 years (range, 49-84) and two-thirds was male. The average
BMI was 21.7±3.9 and FEV1 was 54.0±28.0 % of predicted value. Two-thirds had combined COPD
assessment categorized in group D (high risk, more symptoms). Most of patients (58.1%) had
dyspnea level in mMRC 1 and 48.4% had CAT score interpreting as low health status impairment.
After program implementation, the average mMRC dyspnea score declined from 1.52 to 1.10
(p<0.001). Among these, 38.7% had at least 1 level of dyspnea improvement (mMRC-1). The
average CAT score declined from 12.3±8.9 to 6.2±5.4 (p<0.001). Acute exacerbation rate and
admission rate were reduced from 93.5% to 41.9% and 100% to 64.5% respectively (p<0.001).
Six-minute-walk distance increased from 229±85 m to 259±92 m (p=0.002). 61.3% and 35.5%
of patients gained distance >30 m and >54 m respectively. Reductions of treatment cost were
40% for OPD and 75% for IPD cases.
Conclusion: Comprehensive management program for complex COPD patients could significantly
reduce the dyspnea level, acute exacerbation, hospitalization, cost of treatment and improve
quality of life.


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โรจนวิภาต จ. (2016). Outcomes of Management Program in Complex COPD Patients in Tha Wang Pha Hospital, Nan Province. Lampang Medical Journal, 37(2), 33–45. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/185842
Original Article


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