Evaluation of home oxygen provision in east London: A study of appropriateness of ordering; and patient understanding and compliance

Introduction: In the UK, commissioners fund home oxygen via a tariff based on flow rate, hours of prescribed usage, and mode of delivery; each specified on an oxygen order form (HOOF). Aims: Over six months, records from the local supplier (Air Products) showed 130 patients were under-using oxygen by at least 75% of that ordered. This study aimed to evaluate why. Methods: Diagnoses and reasons for oxygen provision were obtained from electronic records. Patients were telephoned to explore understanding of the need for oxygen, health benefits, and their individual order. Some were deceased (11), were children, or were not contactable. Data on contactable adults, who agreed to interview (45), are presented. Results: Commonest reasons for oxygen provision were COPD and obesity hypoventilation/obstructive sleep apnoea. 47% (21/45) could not name their oxygen-requiring condition. 27% (12/45) were unaware of beneficial effects. 22% (10/45) were unaware how much they were supposed to use. In 63% (22/35), recollection of their oxygen order did not tally with HOOF data. 60% (27/45) admitted to using less than instructed to. Commonest reasons were that it felt unnecessary and intrusive. Most (64%: 29/45) would use more if advised to do so, but 51%: (23/45) would be unhappy for oxygen to be removed if advised it became unnecessary. Discussion: To ensure the NHS pays for only oxygen that is used, suppliers must be notified of changing patient cirumstances and requirements. Verbal instructions during clinic attendances must be accompanied by a faxed new order (HOOF). Improved education should empower patients and translate into a reduction in oxygen underusage.