Article

Problèmes respiratoires
OBJECTIVE: To establish a cost-effective telephone-accessed consultation and
mechanical in-exsufflation (MI-E) and manually assisted coughing, oximetry
feedback program for 39 patients with amyotrophic lateral sclerosis. DESIGN:
Rapid access to healthcare consultation and to MI-E was provided to treat
episodes of distress as a result of secretion encumbrance not reversed by
suctioning and associated with a decrease in oxyhemoglobin saturation (SpO(2))
baseline. Avoided hospitalizations, defined by relief of respiratory distress and
return of SpO(2) baseline to >or=95% by continuous ventilator use and assisted
coughing, were recorded. Patient satisfaction was queried at 6 mos, and a cost
analysis was performed of continuous vs. on demand MI-E use. RESULTS: Thirty-nine
patients made a total of 1661 calls in 7.46 +/- 5.8 mos of follow-up.
Twenty-seven patients had 66 home care visits by a respiratory therapist for a
total time commitment of 89.7 +/- 99.3 min/patient/mo. Twelve patients, all
ventilator users, were also brought mechanical in-exsufflators for mechanically
assisted coughing for 47 respiratory episodes. Thirty hospitalizations were
avoided. Seventy-five percent of the patients were extremely satisfied. Mean
monthly cost per patient for on-demand telephone consultation, professional home
healthcare visits, and MI-E as deemed necessary was euro403 +/- euro420 or 59%
less than for continuous MI-E rental. Hospitalization costs were also spared.
CONCLUSIONS: An on-demand consult and MI-E access program can avoid
hospitalizations for patients with amyotrophic lateral sclerosis with significant
cost savings.

Langue : ANGLAIS