The following methods were adopted for this review of portable oxygen therapy:
Review of the published literature
Analysis of data (via established inform-ation systems) on the provision of services in Québec for COPD patients
Semi-structured interviews with clinical and administrative leaders of home oxygen therapy programs in Québec; collection of supporting documentation
Analysis of data collected in a separate study of CLSCs in Québec regarding in-volvement in home care services
Key informant survey with home oxygen program leaders in other jurisdictions (On-tario and Alberta); collection of supporting documentation
In addition, we followed the progress of the multi-centre clinical trial of portable oxygen therapy based at Hôpital Laval (Québec) un-der the direction of Dr. Yves Lacasse.
3.1 REVIEW OF THE LITERATURE
The literature search included items indexed up to the end of May 2003.
The following databases were searched:
PubMed (National Library of Medicine;
includes Medline and pre-Medline) (1980-2003)
HealthSTAR (1980-2003)
BIOETHICSLINE (1992-2003)
Current Contents (1999-2003)
The Cochrane Library (2001, 2002 and 2003—Issues 1 and 2)
The Québec MSSS Library (1980-2003)
AETMIS Resource Centre
The search terms included: oxygen, home, domiciliary, portable, ambulatory, oxygen services, COPD, safety, organization, eco-nomics, ethics OR ethical, law OR legal. The search was limited to papers published in Eng-lish and French. Papers pubEng-lished in other languages with English abstracts were not in-cluded given the difficulties related to assess-ing the validity of the research and/or inter-preting the results.
For the section on clinical effectiveness, the search was limited to clinical trials of portable oxygen therapy, and data from longitudinal cohort studies. For the sections on cost-effectiveness, safety, organization and ethical-legal issues, a broader range of study method-ology was considered, including: prospective controlled studies; retrospective reviews; sur-veys of utilization; case studies; descriptive studies; comparative studies; costing studies;
economic evaluations; and, review papers.
Given that the Québec trial was premised on the lack of scientific evidence investigating the costs and benefits of portable oxygen ther-apy, relatively broad inclusion criteria were established for research reporting data on the clinical and cost-effectiveness of portable oxygen therapy:
▪ Sample group included COPD patients with hypoxaemia
▪ Patients received portable oxygen (via compressed gas or liquid delivery systems) as a component of LTOT therapy at home
▪ Cohort analysis (retrospective, prospective, or cross-sectional design) or randomized trial evaluation
▪ Outcomes assessed included quality of life Abstracts retrieved via electronic searches were reviewed by two researchers (SL and PL) to identify appropriate studies for inclusion in this review. A database of studies collected for the
review was established at AETMIS (by SL) us-ing ProCite Version 5.
For this review, approximately 330 papers were initially retrieved for consideration; ad-ditional papers were identified in reference lists of retrieved and other documents; data/
information from 139 papers was extracted for this report and included in the reference list.
Twelve studies (summarized in Appendix C) were retrieved that contained data relevant to the clinical effectiveness and use of portable therapy; only one [Vergeret et al., 1989] com-pared portable oxygen therapy versus fixed oxygen therapy using randomized allocation of the patients but non-standardized tools for assessment.
3.2 QUÉBEC DATA ON COPD
Data on hospitalization rates for COPD in Québec, and on estimates of prevalence of COPD were obtained through reports pub-lished by MSSS.
3.3 INTERVIEWS WITH KEY PROVIDERS
In Québec, 12 interviews were conducted (7 face-to-face and 5 telephone interviews), involving 22 participants (see table 1 below), with lead clinicians and managers of home oxygen therapy in Québec; site visits were conducted in Montréal, Sherbrooke and Ste-Foy, Québec. Written documentation about programs and services was collected where available during these interviews. One of the three major suppliers of home oxygen equip-ment and supplies completed and returned the questionnaire regarding suppliers’ involve-ment and perspectives on home oxygen ser-vices9.
9. Numerous attempts at follow-up (by telephone and fax) were made to the other two major suppliers in Québec without suc-cess.
The interview framework developed to guide the interviews with the clinical providers is appended (see Appendix A: Interview Frame-work for Clinical Teams). This was adapted to interview government staff, patient represen-tatives and suppliers (see Appendix B: Survey of Québec Suppliers). Interviews were confi-dential; participants were assured that com-ments would not be attributable to interview-ees in the final report.
A transcript was prepared from the notes taken during the interviews (SL and PL). Con-tent analysis of the text was conducted as per standard methodology for qualitative inquiry [Patton, 2002; Berg, 2001] to identify descrip-tive elements and perceptions regarding cur-rent issues.
3.4 SURVEY OF QUÉBEC CLSCs
A survey of Québec CLSCs was funded by the Canadian Institutes of Health Research (CIHR, #MA-15472) and conducted in 1999-2001. The aim of the research was to identify the organizational, technical, and human fac-tors influencing the use of technology in home care by all CLSCs in Québec. A mail-back survey was sent to 140 CLSCs. A response rate of close to 70% was obtained for the sur-vey questionnaire which was considered satis-factory given the length of the survey (more than 30 close-ended questions), and given the pressure under which CLSCs were operat-ing—to reorganize and deliver home care ser-vices—at the time of the study.
3.5 EXPERIENCE OF OTHER JURISDICTIONS
Lead clinicians and managers were inter-viewed in Ontario and Alberta (telephone in-terviews). Method of documentation and analysis was as for Québec interviews.
TABLE 1
Key Informant Survey Participants—Québec
POSITION / PROFESSION NUMBER
Respirologists 2
Nurses 8
Research physiotherapist 1
Respiratory therapists (RT) 5
MSSS/Régie staff 3
Patient Association rep./carer 2
Supplier 1
Total participants : 22