Frequency of emergency department visits and hospitalizations due to chronic obstructive pulmonary disease exacerbations in patients included in two models of care
Abstract
Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) have a huge impact on lung function, quality of life and mortality of patients. Emergency Department visits and hospitalizations due to exacerbations cause a significant economic burden on the health system.
Objective: To describe the differences in the number of emergency visits and hospitalizations due to exacerbations of COPD among patients included in two models of care of the same institution.
Materials and methods: A historical cohort study in which COPD patients who are users of two models of care were included: COPD integrated care program (CICP) and general consultation of pulmonology (GCP). The first model, unlike the second one, offers additional educational activities, 24/7 telephone service, and priority consultations. The number of emergency visits and hospitalizations due to COPD exacerbations in patients who had completed at least one year of follow-up was evaluated. The multivariable Poisson regression model was used for calculating the incidence rate (IR) and the incidence rate ratio (IRR) with an adjustment for confounding factors.
Results: We included 316 COPD patients (166 from the CICP and 150 from the GCP). During the year of follow-up, the CICP patients had 50% fewer emergency visits and hospitalizations than patients from the GCP (IRR=0.50, 95%CI: 0.29-0.87, p=0.014).
Conclusions: COPD patients in the CICP had fewer emergency visits and hospitalizations due to exacerbations. Prospective clinical studies are required to confirm the results and to evaluate the factors that contribute to the differences.
Downloads
References
Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2015;5:020415. https://doi.org/10.7189/jogh.05-020415
Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148:971-85. https://doi.org/10.1378/chest.14-2535
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442. https://doi.org/10.1371/journal.pmed.0030442
Menezes AM, Pérez-Padilla R, Jardim JR, Muino A, López MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): A prevalence study. Lancet. 2005;366:1875-81. https://doi.org/10.1016/S0140-6736(05)67632-5
Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, et al. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest. 2008;133:343-9. https://doi.org/10.1378/chest.07-1361
Eisner MD, Anthonisen N, Coultas D, Kuenzli N, Pérez-Padilla R, Postma D, et al. An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;182:693-718. https://doi.org/10.1164/rccm.200811-1757ST
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. Accessed: February 8, 2018. Available from: http://goldcopd.org/gold-2017-global-strategydiagnosis-management-prevention-copd/
Torres-Duque CA, García-Rodríguez MC, González-García M. Is chronic obstructive pulmonary disease caused by wood smoke a different phenotype or a different entity? Arch Bronconeumol. 2016;52:425-31. https://doi.org/10.1016/j.arbres.2016.04.004
Departamento Administrativo Nacional de Estadística (DANE). Estadisticas vitales, nacimientos y defunciones. Defunciones no fetales. Defunciones por grupo de edad y sexo según departamentos de ocurrencia y grupos de causa de defunción. Accessed: March 7, 2018. Available from: http://www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientos-y-defunciones/defunciones-no-fetales/defunciones-no-fetales-2010
Yin HL, Yin SQ, Lin QY, Xu Y, Xu HW, Liu T. Prevalence of comorbidities in chronic obstructive pulmonary disease patients: A meta-analysis. Medicine (Baltimore). 2017;96:e6836. https://doi.org/10.1097/MD.0000000000006836.
Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano A Jr, et al. Interventions used in disease management programmes for patients with chronic illnesswhich ones work? Meta-analysis of published reports. BMJ. 2002;325:925. https://doi.org/10.1136/bmj.325.7370.925
Kruis AL, Smidt N, Assendelft WJ, Gussekloo J, Boland MR, Rutten-van Molken M, et al. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;10:CD009437. https://doi.org/10.1002/14651858.CD009437
Chavannes NH, Grijsen M, van den Akker M, Schepers H, Nijdam M, Tiep B, et al. Integrated disease management improves one-year quality of life in primary care COPD patients: A controlled clinical trial. Prim Care Respir J. 2009;18:171-6. https://doi.org/10.3132/pcrj.2009.00003
Kruis AL, Boland MR, Assendelft WJ, Gussekloo J, Tsiachristas A, Stijnen T, et al. Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: Results of cluster randomised trial. BMJ. 2014;349:g5392. https://doi.org/10.1136/bmj.g5392
Casas A, Troosters T, García-Aymerich J, Roca J, Hernández C, Alonso A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28:123-30. https://doi.org/10.1183/09031936.06.00063205
Jain VV, Allison R, Beck SJ, Jain R, Mills PK, McCurley JW, et al. Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD. Respir Med. 2014;108:1794-800. https://doi.org/10.1016/j.rmed.2014.09.010
Tsiachristas A, Burgers L, Rutten-van Molken MP. Cost-effectiveness of disease management programs for cardiovascular risk and COPD in The Netherlands. Value Health. 2015;18:977-86. https://doi.org/10.1016/j.jval.2015.07.007
Mullerova H, Maselli DJ, Locantore N, Vestbo J, Hurst JR, Wedzicha JA, et al. Hospitalized exacerbations of COPD: Risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147:999-1007. https://doi.org/10.1378/chest.14-0655
Asociación Latinoamericana de Tórax. Recomendaciones para el diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC). Accessed: March 19, 2019. Available from: https://alatorax.org/es/epoc/guia-epoc-alat
Londoño D, García OM, Celis C, Giraldo M, Casas A, Torres CA, et al. Guía de práctica clínica basada en la evidencia para la prevención, diagnóstico, tratamiento y seguimiento de la enfermedad pulmonar obstructiva crónica (EPOC) en población adulta. Acta Médica Colombiana. 2014;2(Supl.3):5-48.
Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al. An official American Thoracic Society/European Respiratory Society policy statement: Enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med. 2015;192:1373-86. https://doi.org/10.1164/rccm.201510-1966ST
Rodríguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117:398S-401S. https://doi.org/10.1378/chest.117.5_suppl_2.398S
Whitehead J. The design and analysis of sequential clinical trials. Second edition. New York; Wiley; 1992. p. 328.
García-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: A population based cohort study. Thorax. 2006;61:772-8. https://doi.org/10.1136/thx.2006.060145
Hosmer DW, Lemeshow S, Sturdivant RX. Model-building strategies and methods for logistic regression. In: Hosmer DW, Lemeshow S, Sturdivant RX, editors. Applied logistic regression. Third edition. New York: John Wiley & Sons, Inc.; 2013. p. 89-153.
Hosmer DW, Lemeshow S, Sturdivant RX. Special topics, mediation. In: Hosmer DW, Lemeshow S, Sturdivant RX, editors. Applied logistic regression. Third edition. New York: John Wiley & Sons, Inc.; 2013. p. 441-8.
Troosters T, Gosselink R, Decramer M. Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: A randomized trial. Am J Med. 2000;109:207-12. https://doi.org/10.1016/S0002-9343(00)00472-1
Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000;117:976-83. https://doi.org/10.1378/chest.117.4.976
Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169:1298-303. https://doi.org/10.1164/rccm.200310-1443OC
Rice KL, Dewan N, Bloomfield HE, Grill J, Schult TM, Nelson DB, et al. Disease management program for chronic obstructive pulmonary disease: A randomized controlled trial. Am J Respir Crit Care Med. 2010;182:890-6. https://doi.org/10.1164/rccm.200910-1579OC
Destache CJ. Optimizing economic outcomes in acute exacerbations of chronic bronchitis. Pharmacotherapy. 2002;22:12S-7S.
Wedzicha JA, Banerji D, Chapman KR, Vestbo J, Roche N, Ayers RT, et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med. 2016;374:2222-34. https://doi.org/110.1056/NEJMoa1516385
Wedzicha JA, Decramer M, Ficker JH, Niewoehner DE, Sandstrom T, Taylor AF, et al. Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): A randomised, double-blind, parallel-group study. Lancet Respir Med. 2013;1:199-209. https://doi.org/10.1016/S2213-2600(13)70052-3
Machado-Alba JE, Bañol-Giraldo AM. Patrones de prescripción de broncodilatadores y corticoides inhalados en pacientes adultos de Colombia. Acta Médica Colombiana. 2015;40:218-26.
Some similar items:
- Andrés Leonardo González, Ruth Aralí Martínez, Luis Ángel Villar, Clinical evolution of dengue in hospitalized patients , Biomedica: Vol. 28 No. 4 (2008)
- Luz E. Botero, Andrés E. Toro, Alber J. Patiño, Guillermo Salazar, Juan C. Rodríguez, Juan C. Suárez-Escudero, Gustavo A. Alarcón, Ana Corcimaru, Cristina Osorio, Joseph S. Y. Jeong, Oscar Alzate, Diabetes mellitus in patients with Alzheimer’s disease: clinical description and correlation with the APOE genotype in a sample population from the province of Antioquia, Colombia , Biomedica: Vol. 32 No. 2 (2012)
- Jorge Mario Estrada-Alvarez, Juan Pablo Orozco-Hernández, Dr. Aristizabal-Franco, Validation of chronic obstructive pulmonary disease severity score (COPDSS) for primary care in a Colombian population , Biomedica: Vol. 40 No. 4 (2020)
- Raúl Murillo, Ricardo Cendales, Carolina Wiesner, Marion Piñeros, Sandra Tovar, Effectiveness of cytology-based cervical cancer screening in the Colombian health system , Biomedica: Vol. 29 No. 3 (2009)
- Sandra Lorena Girón, Julio César Mateus, Fabián Méndez, Impact of an open waste disposal site on the occurrence of respiratory symptoms and on health care costs of children , Biomedica: Vol. 29 No. 3 (2009)
- Alvaro Vallejos, Adverse reactions by antibiotics in a pediatric and neonatal intensive care unit located in Bogotá, Colombia , Biomedica: Vol. 27 No. 1 (2007)
- Beatriz Eugenia Alvarado, Elizabeth Gómez, Mauricio Serra, Rocío Carvajal, Gabriel Carrasquilla, Evaluation of an educational strategy on malaria in rural areas of the Colombian Pacific , Biomedica: Vol. 26 No. 3 (2006)
- Beatriz Eugenia Alvarado, Alberto Alzate, Julio Cesar Mateus, Rocío Carvajal, Effects of an educational and participatory community intervention on malaria control in Buenaventura, Colombia , Biomedica: Vol. 26 No. 3 (2006)
- Mabel Carabalí, Clara Beatriz Ocampo, María Eugenia Toledo, Lyda Osorio, Mass communication of dengue surveillance data: effect of an intervention in Guadalajara de Buga, Colombia , Biomedica: Vol. 33 (2013): Suplemento 1, Fiebres hemorrágicas
- Sergio Velásquez, Juan D. Matute, Laura Y. Gámez, Luis E. Enríquez, Iván D. Gómez, Fabiola Toro, Martha L. Valencia, Gisela De La Rosa, Pablo J. Patiño, Fabián A. Jaimes, Characterization of nCD64 expression in neutrophils and levels of s-TREM-1 and HMGB-1 in patients with suspected infection admitted in an emergency department , Biomedica: Vol. 33 No. 4 (2013)
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
