Factors Associated with Frequency of Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

BACKGROUND:Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations. OBJECTIVE:To characterize the use of emergency department (ED) services in patients with COPD exacerbation and identify factors associated with FEDV. DESIGN:A prospective, multicenter cohort study.PATIENTS: Three hundred eighty-eight patients were included. Fifty-two percent were women and the median age was 69 years (interquartile range 62-76).MEASUREMENTS: Using a standard questionnaire, consecutive ED patients with COPD exacerbation were interviewed. The number of ED visits in the previous year was retrospectively collected. RESULTS:Over the past year, this cohort reported a total of 1,090 ED visits because of COPD exacerbation. Thirteen percent of COPD patients had 6 or more ED visits, accounting for 57% of the total ED visits in the past year. Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.16-3.33), to have more severe COPD as determined by previous hospitalizations (IRR 2.06, 95% CI 1.51-2.82), prior intubations (IRR 1.49, 95% CI 1.02-2.18), prior use of systemic corticosteroids (IRR 1.57, 95% CI 1.16-2.13) and methylxanthine (IRR 1.48, 95% CI 1.04-2.12), and less likely to have a primary care provider (IRR 0.51, 95% CI 0.31-0.82). CONCLUSIONS:Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.KEY WORDS: chronic obstructive pulmonary disease; emergency department visits; primary care provider; recurrent exacerbation. Abbreviations COPDChronic obstructive pulmonary disease ED Emergency department

Population-Based Burden of COPD-Related Visits in the ED

“…In the literature, some cohorts have a very high prevalence of hypertension (63.4%), 19 whereas others, including ours (42%), are within the 40% to 60% range. [20][21][22] Our congestive heart failure estimate 15 ; similarly, we found cohort members with a "COPDother" comorbidity (490.x, bronchitis, not specifi ed as acute or chronic), at less risk of subsequent hospital admission. Interestingly, "substance-related disorders" comorbidity, although present in only a small percentage (1.5%, 512 of 33,799) of the cohort, had the largest association with increased subsequent hospital admission among the comorbidities we examined.…”

“…However, these detailed codes (491, 492, 496) have been shown to have good sensitivity (85%) and modest specifi city (78.4%). 8,27 Second, we chose to of 21% was substantially higher than the 5% to 7% in Soriano et al 23 and Curkendall et al 22 but closer to the 15% found by Tsai et al 15 Some of these differences are likely due to the proportion of one sex vs another among the cohorts; other differences may be due to variations in ED coding practices.…”

“…We found patients on Medicare or Medicaid or noninsured patients were consistently more likely to have subsequent 30-day, 365-day, and multiple COPD ED visits within 365 days. Although Tsai et al 15 similarly found Medicaid was associated with increased COPD ED visits, "other public (all Canadian and Medicare)" insurance was not. Similar to Watson et al, 16 we found no sex differences for ED visits.…”

Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort

“…These conditions are known as Ambulatory Care Sensitive Conditions (ACSCs) and include, as an example, diabetes, respiratory diseases, various cardiovascular diagnoses, and convulsive disorders 36 . The protective effect of GP accessibility and the pattern of GP contact against potentially preventable hospital admissions and adverse health events has been supported by several previous studies 35, [37][38][39][40][41] . As an example, high primary care physician density appears to protect against potentially preventable hospital admissions 35 , whereas lack of a 40 , and lack of access to primary care 41 appear to lead to increase in preventable hospitalisations.…”

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

“…We have shown that the frequency of ED visits for AECOPD is associated with not only disease factors, but also healthcare-related factors. 29 The consistently high ED visits for AECOPD might be related to the remaining challenges in our healthcare system, such as shortage of primary care and ⁄ or lack of universal insurance coverage. 30 The significant improvement in some ED treatments of AECOPD nicely parallels the advance in our understanding of AECOPD over the past decades.…”