COPD在宅酸素療法実施者への在宅モニタリングに基づくテレナーシング実践の急性増悪および再入院予防効果―ランダム化比較試験による看護技術評価

Preventing Acute Respiratory Exacerbation and Readmission of Chronic Obstructive Pulmonary Disease（COPD） Patients with Home Oxygen Therapy: Evaluation of Home-Monitoring Based Telenursing Practice by a Randomized-Controlled Trial

要旨

　目的：COPD HOT実施者を対象として，在宅モニタリングに基づくテレナーシング（TN）を3ヵ月間提供し，急性増悪（primary outcome），および再入院（secondary outcome）をエンドポイントとして，ランダム化比較試験により効果を検討した．

　方法：対象は，COPD HOT実施者37名を介入群20名（平均年齢76.0歳），対照群17名（77.7歳）に無作為に割り付けた．方法は，介入群には毎日TNを提供し，対照群は従来の診療のみとした．

　結果：対象特性として，介入群の介入直前の在院日数は対照群よりも有意に長かった．介入群はTNにより急性増悪発症者が32.9%減少した．また，発症までの日数は有意に長く，介入前・中一人当たり急性増悪発症回数は介入群のみ有意に減少した．再入院割合は3.5%減少したが有意差はなく，介入前・中一人当たりの再入院回数は介入群のみ有意に減少した．生存分析（Kaplan.Meier法）では，急性増悪について両群間に有意差が認められた．

　結論：在宅モニタリングに基づくTNはCOPD HOT実施者の急性増悪発症予防，および発症回数を低下させる可能性があると示唆された．

Abstract

　Purpose：Using a randomized controlled trial, we aimed to determine the effects of a home monitoring-based telenursing（TN） practice considering two endpoints： preventing acute respiratory exacerbation（primary outcome） and readmission（secondary outcome） among chronic obstructive pulmonary disease（COPD） patients with home oxygen therapy（HOT）.

　Methods：Thirty-seven COPD HOT patients were randomly assigned to TN experimental group（n＝20, mean age 76.0 years） and control group（n＝17, mean age 77.7）. Experimental group was given usual treatment（UT） by the primary care physician plus daily TN for three months. Controls received only UT for three months.

　Results：Experimental group showed significantly higher number of hospitalization bed days before the immediate implementation period. Experimental group acute exacerbations were significantly decreased by TN 32.9%. The onset of acute exacerbation was significantly delayed compared to control group. The frequency of acute exacerbation during the three months was significantly decreased for the experimental group. TN insignificantly decreased readmissions 3.5%. Readmissions during the three months were significantly decreased for the experimental group compared to controls. Acute respiratory exacerbation ratios and readmission rates compared by Kaplan.Meier analysis showed that acute exacerbations were prevented in experimental group.

　Conclusions：Home monitoring-based TN has the potential to prevent and decrease the frequency of acute respiratory exacerbations in COPD HOT patients.