Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.
Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study.
复制标题
DOI：
10.2147/copd.s120776
复制
发表时间：
2016
影响因子：
2.8
通讯作者：
Surmont F
中科院分区：
文献类型：
--
作者：
Montes de Oca M;Aguirre C;Lopez Varela MV;Laucho-Contreras ME;Casas A;Surmont F
COPD、哮喘和哮喘-COPD重叠增加了卫生保健资源消耗，主要是因为急性加重住院以及全科医生（GP）或专家就诊增加。在初级保健环境中，关于这一点的信息很少。描述COPD、哮喘和哮喘-COPD重叠患者因任何原因或因急性加重而进行GP和专家访视的患病率和次数。COPD定义为使用支气管扩张剂后1秒用力呼气量/用力肺活量（FEV 1/FVC）比值<0.70;哮喘定义为既往医学诊断、过去12个月内有喘鸣或喘鸣+可逆性（使用支气管扩张剂后FEV 1或FVC增加≥200 mL且≥12%）;哮喘-COPD重叠定义为使用支气管扩张剂后FEV 1/FVC <0.70+既往哮喘诊断。卫生保健利用率被评估为前一年的GP和/或专家访问。在完成问卷的1,743人中，1,540人进行了可接受的肺功能测定。COPD患者与非COPD患者相比，任何医生就诊的患病率更高（分别为37.2%和21.8%），急性加重使就诊次数增加一倍。哮喘患者就诊率也高于非哮喘患者（喘息：47.2% vs 22.7%;医学诊断：54.6% vs 21.6%;喘息加可逆性：46.2% vs 23.8%）。哮喘急性发作患者的就诊次数是未发作患者的两倍。哮喘-COPD重叠、哮喘（1.9倍）或COPD（1.4倍）患者的访视次数高于无这些呼吸系统疾病的患者（2.8倍）;哮喘-COPD重叠、哮喘（3.5倍）和COPD（3.8倍）患者因急性加重而进行的访视次数也较高（4.9倍）。慢性阻塞性肺病、哮喘和哮喘-慢性阻塞性肺病重叠增加了就诊率，因此增加了卫生保健资源利用率。减少这些患者医疗资源使用的尝试需要旨在预防病情加重的干预措施。
COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. COPD, asthma, and asthma–COPD overlap increase the prevalence of medical visits and, therefore, health care resource utilization. Attempts to reduce health care resource use in these patients require interventions aimed at preventing exacerbations.