Frequent Outpatient Visits Prevent Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease requiring frequent outpatient visits and lifelong management. We aimed to evaluate the roles of frequent outpatient visits in prognosis of COPD. We used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea from May 1, 2014 to April 30, 2015. A definition of COPD was used based on the diagnosis code and medication. Frequent visitors were defined as subjects who visited the outpatient clinic for COPD three or more times per year. Among 159,025 subjects, 117,483 (73.9%) were classified as frequent visitors. Frequent visitors underwent pulmonary function tests and used various inhalers more often than did infrequent visitors. The rates of COPD exacerbation requiring admission to a general ward, emergency room, or intensive care unit were significantly lower in frequent visitors than in infrequent visitors. In multivariable analysis, frequent visits were identified as an independent factor preventing COPD exacerbation that required admission to a ward (odds ratio [OR], 0.387), emergency room, (OR, 0.558), or intensive care unit (OR, 0.39) (all P < 0.001). In conclusion, we showed frequent outpatient visits reduce the risk of COPD exacerbation by 45-60%.ope

All-Cause and Cause-Specific Mortality Attributable to Seasonal Influenza: A Nationwide Matched Cohort Study

Background: Although influenza poses substantial mortality burden, most studies have estimated excess mortality using time-aggregated data. Here, we estimated mortality risk and population attributable fraction (PAF) attributed to seasonal influenza using individual-level data from a nationwide matched cohort. Methods: Individuals with influenza during four consecutive influenza seasons (2013-2017) (n = 5,497,812) and 1:4 age- and sex-matched individuals without influenza (n = 20,990,683) were identified from a national health insurance database. The endpoint was mortality within 30 days after influenza diagnosis. All-cause and cause-specific mortality risk ratios (RRs) attributed to influenza were estimated. Excess mortality, mortality RR, and PAF of mortality were determined, including for underlying disease subgroups. Results: Excess mortality rate, mortality RR, and PAF of all-cause mortality were 49.5 per 100,000, 4.03 (95% confidence interval [CI], 3.63-4.48), and 5.6% (95% CI, 4.5-6.7%). Cause-specific mortality RR (12.85; 95% CI, 9.40-17.55) and PAF (20.7%; 95% CI, 13.2-27.0%) were highest for respiratory diseases. In subgroup analysis according to underlying disorders, PAF of all-cause mortality was 5.9% (95% CI, 0.6-10.7%) for liver disease, 5.8% (95% CI, 2.9-8.5%) for respiratory disease, and 3.8% (95% CI, 1.4-6.1%) for cancer. Conclusion: Individuals with influenza had a 4-fold higher mortality risk than individuals without influenza. Preventing seasonal influenza may lead to 5.6% and 20.7% reductions in all-cause and respiratory mortality, respectively. Individuals with respiratory disease, liver disease, and cancer may benefit from prioritization when establishing influenza prevention strategies.ope

Exploring the utilization of healthcare resources in elderly patients with COPD

Background: Chronic obstructive pulmonary disease (COPD) remains a major health problem worldwide (1) and the prevalence of COPD continues to increase (2, 3). It is a major cause of multimorbidity and mortality in Norway (4) and the healthcare utilization by COPD- patients is expected to increase in the future (5). To effectively allocate healthcare resources, it is necessary to have knowledge about how the resources are utilized (6). The present study aimed to describe and explore how elderly patients with COPD utilize healthcare in the health region of South-East in Norway. And to isolate the effect of having COPD by comparing this group of patients with the general population. Methods: This cross-sectional study was based and conducted on data from three different Norwegian registers (KUHR, NPR and DSF). The study sample consisted of COPD-patients aged 66-105 years old, who had at least one contact regarding COPD with either the primary- or specialist healthcare sector between 2012 and 2016. Descriptive analyses were used to describe the sample of COPD-patients and the prevalence of type of contact they generated. Costs related to treatment in the specialist healthcare sector was based on DRG-codes and regression analyses were conducted to investigate the association between number of additional diagnoses, age, sex, and the costs related to treatment. Results: There was a total of 35 185 COPD-patients registered in either the primary- or specialist healthcare sector from 2012 to 2016. This equals on average 6 442 and 2 789 unique COPD-patients registered in KUHR and NPR each year, respectively. The distribution between the sexes were equal, with 44,5% males. Mean birthyear was 1940 and average age was about 74 years old for both sexes. COPD-patients generated on average more than 13 events in the primary healthcare sector and more than five events in specialist healthcare sector, each year. The total cost for treating COPD-patients in the specialist healthcare sector in 2016 exceeded 1.1 billion and the average cost of treatment per COPD-patient in the specialist healthcare sector was 82 247 NOK in 2015. The average cost for females was 5865 NOK lower than it was for males and the average cost per patient increased with 5 293 NOK for each additional diagnose that was added. The costs were more than 3.5 times higher for COPD-patients than it was for the general population. Concentration curves reveals that 20% of the COPD-patients in KUHR are accountable for almost half of the events, and 20% of the COPD-patients in NPR are accountable for 60% of the events. The top 30% of COPD-patients who utilize most healthcare resources have a mean cost of treatment that is almost two times higher than the mean cost of treatment for the average COPD-patient. Conclusion: The number of events COPD-patients generates in the primary- and specialist healthcare sector and the high costs related to treatment in hospitals confirms that COPD- patients imposes significant social and economic burden on patients and society. The results indicates that future research and allocation should focus on COPD-patients with multimorbidity and the share of COPD-patients that utilize the most healthcare resources

Identifying Factors Contributing to Hospital Readmission of Patients With Chronic Obstructive Pulmonary Diseases

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital readmission within 30 days of discharge. However, the factors that contribute to early readmission of COPD patients are not well understood, nor is it clear how to reduce readmission. This study used a qualitative phenomenological approach to examine COPD patients\u27 experience on factors that contribute to the COPD readmission rate and practices that might reduce it. In depth interviews with 10 COPD patients were conducted to explore their lived experiences of factors contributing to hospital readmission with COPD exacerbation. Questions were asked on issues known to affect readmission and the elements of behavior change used in the health belief model, which served as the study\u27s theoretical framework. The results showed that the leading causes of early readmission relate to participants\u27 difficulty making recommended behavior changes and their perception that more education and support are essential in managing and accepting COPD, including a better understanding of the disease\u27s severity. All participants spoke of the need for improved communication with their providers and continuity of care in doctor visits, pulmonary rehab programs, and educational support, especially during the COPD hospital discharge process. This study\u27s results can help develop management programs to reduce the rate of COPD patient readmissions within 30 days, which would reduce health care spending, improve the quality of life for COPD patients, and contribute to a positive social change