Every year, 115,000 COPD exacerbations in the UK are severe enough to require hospitalisation—and 43% of those patients are readmitted within 90 days. This trial tests whether giving patients a “rescue pack” of steroids and antibiotics at discharge, combined with a comprehensive self-management plan and twice-weekly automated phone messages, can cut that rate by 20% compared to standard care. Current NICE-recommended rescue packs alone have not reduced readmissions. The researchers’ own quality improvement data suggests that adding regular telephone support can lower readmissions by 30%. If this nationwide, 48-month trial succeeds, the intervention—a written management plan, a five-day drug course, and automated symptom-checking calls—could be rolled out immediately across the NHS. That would mean fewer emergency returns to hospital, lower healthcare costs, and better quality of life for the roughly 10% of adults worldwide living with COPD. The study also includes interviews with patients and clinicians to understand what works and why, ensuring the results translate into real-world practice.
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Research question: Can rescue packs and a comprehensive self-supported management plan reduce readmissions following exacerbation of COPD? Background: Chronic obstructive pulmonary disease (COPD) affects approximately 10% of the adult population globally. The disease course is punctuated by exacerbations, which are associated with significant morbidity, healthcare costs and mortality. In the UK, approximately 115,000 exacerbations are severe enough to warrant hospitalisation each year. National audit data demonstrates that unfortunately, following discharge from hospital, 43% of patients will be readmitted to hospital within 90 days (making this a high-risk period). The National Institute for Health and Care Excellence (NICE) recommends that hospital clinicians looking after patients with COPD should provide rescue packs (a course of prednisolone and antibiotics) and a basic management plan to patients on discharge to use in the event of deterioration. However, this has not reduced readmissions. Our team has quality improvement data which shows that twice-weekly telephone messaging to patients with COPD following discharge, supporting rescue pack use an reduce readmissions by 30%, with good patient satisfaction. We hypothesise that rescue packs on discharge in addition to a comprehensive self-supported management plan, consisting of the Asthma + Lung UK written management plan (with translations) and twice weekly automated phone messaging during the 90-day high-risk period will reduce readmissions by 20% compared to standard care. Objectives: 1. Complete an internal pilot study, embedded within the trial to assess recruitment rates, retention rates, primary outcome data and all aspects of trial management. This will support a go- no go- decision at 18 months. 2. Conduct a multi-centre randomised self-supported management clinical trial across acute hospital trusts in England, Scotland, N. Ireland and Wales 3. Perform a qualitative sub-study to characterise variation in standard care to inform and interpret the primary data, by interviewing healthcare practitioners. 4. Perform a qualitative sub-study to understand intervention delivery, preparing for clinical adoption and interpretation of the primary results, by interviewing people with COPD who have taken part in the study. 5. Quantify the health economic benefits of the intervention against standard care. Methods: This is a mixed-methods study consisting of a randomised clinical trial, health economics analysis and interview-based qualitative research sub-studies. Primary Outcome: Time to first all-cause readmission within 90 days of discharge. Intervention: Rescue pack (5 days of 30mg prednisolone to be taken once a day + 5 days of antibiotics) & written Asthma + Lung UK management plan (with translations, for equality and diversity) & twice weekly automated symptom rating telephone calls (or text messaging, for inclusivity) for 90 days. Timelines for delivery: We anticipate this study will take 48 months to complete. Anticipated impact and dissemination: This nationwide study has been designed by leaders in COPD care across the acute and community pathway an in partnership with patients. If successful results will be readily implementable in clinical practice, translating to better standards of care and improved clinical outcomes and reduced costs to the NHS.
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