Objective: Almost every country in the developed world
has a domiciliary oxygen program. Whether recipients meet program
criteria has not been rigorously studied.
Participants: Two hundred
thirty-seven patients receiving domiciliary oxygen in the Ontario
Ministry of Health Home Oxygen Program (HOP).
A respiratory therapist visited the patients’ homes and administered
questionnaires, obtained resting arterial blood gas measurements, and
conducted a standardized home exercise test while monitoring oxygen
saturation using an oximeter.
Measures of outcome: We
evaluated the extent to which patients met HOP criteria that are based
on the inclusion criteria of randomized trials showing the
life-prolonging effects of domiciliary oxygen. We also assessed the
extent to which the patients’ oxygen prescription was consistent with
the results of rest and exercise testing.
Ninety-six of 237 participants (40.5%; 95% confidence interval, 34.3
to 46.8) did not meet criteria for home oxygen. Patients aged ≤ 70
years were more likely to meet criteria (71 of 105 patients; 67.9%)
than those > 70 years old (70 of 132 patients; 53.0%). The
proportion of patients meeting criteria was similar whether the
referring physician was a specialist (71 of 112 patients; 62.5%) or a
primary-care physician (69 of 123 patients; 56.1%). A very important
health benefit from oxygen was identified among 82% of those who met
criteria and 88% of those who did not. Patients received higher flow
rates than our criteria suggested were appropriate. Agreement between
the independently assessed oxygen prescription at rest and the
patients’ report of oxygen use was extremely poor (chance-corrected
agreement [κ], 0.17), as was agreement concerning optimal exercise
flow rates (κ, 0.26).
procedures for administration and reimbursement of home oxygen result
in a large proportion of recipients not meeting criteria, as well as
the prescription of excessive oxygen flow rates. These results are
likely to apply to many jurisdictions and suggest a large potential for
more efficient resource allocation.