Deployment of integrated care services for patients with long-term oxygen therapy (LTOT): Role of frailty

Patients receiving LTOT are frequent users of healthcare services. Pilot studies have shown that Integrated Care Services (IC) reduce hospitalizations in these patients and have also identified that deployment of ICS requires an operational definition of frailty that allows risk stratification of patients. Objective: To characterize the risk profile of LTOT patients in an urban area of 540.000 inh in order to allow the design of a one-year follow-up RCT to assess deployment of IC tailored by patient9s frailty. Methods: Observational study examining 751 patient9s records. We planned three home visits for health examination survey, assessment of determinants of frailty, measurement of arterial blood gases and perceived needs. Up to 423 (56%) patients with active LTOT were studied. Preliminary data from an unbiased sample of 282 patients are reported. Results: Eighty six patients (31%) had a P0 2 ≤ 55 mmHg and only 62 of them (22%) used LTOT ≥ 16 h/day. Most patients had never received an educational program (94%) or home care support (74%). Among several frailty indicators, the Canadian scale (CS) showed an association with the adequacy and hours of administration of LTOT. Patients with career but without other dependent persons at home [OR 3.56 (1.29–9.78)], higher CS of frailty [2.88 (1.09–7.60)] and high treatment score (5 to 9 drugs) [3.78 (1.05–13.6)] showed better LTOT adherence.Factors related with organization of healthcare services had impact on LTOT adherence [0.45 (0.22–0.91)]. Conclusions: The study provides the rationale for future actions on modifiable factors aiming at enhancing quality of LTOT. Supported by Nexes (FP7-CIP-ICT- 225025) and Esteve-Teijin.