Acute Exacerbations of Chronic Obstructive Pulmonary Disease and the Effect of Existing Psychiatric Comorbidity on Subsequent Mortality

Abrams, Thad E.; Vaughan-Sarrazin, Mary; Weg, Mark W Van der

doi:10.1016/j.psym.2011.03.005

Cited by 64 publications

(52 citation statements)

References 36 publications

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“…Similar to prior studies, we found that patients with COPD with low socioeconomic status, 33,34 psychosis, 35 and alcohol abuse 36 had higher readmission rates. This is likely related to limited capacity of these patients to meet the workload of disease burden, poor social support, and nonadherence with treatment.…”

Section: Discussionsupporting

confidence: 90%

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

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Section: Discussionsupporting

confidence: 90%

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

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“…Depression affects between 20% and 60% of COPD patients depending on the study, COPD stage and the scale used [65][66][67]. The mortality and readmission rate among anxious and/or depressive COPD patients increases during the 30 days following hospitalisation [68]. The presence of depression has prognostic value, as shown in a study in COPD patients hospitalised for exacerbation [69].…”

Section: Anxiety and Depression Disordersmentioning

confidence: 99%

Comorbidities of COPD

Cavaillès¹,

Brinchault-Rabin²,

Dixmier³

et al. 2013

Eur Respir Rev

419

285

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By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation.All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. @ERSpublications Extrapulmonary comorbidities are common in COPD and influence prognosis; we propose an exhaustive comorbidities review

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“…Eight independent studies with a prospective design and which included a measure of anxiety at baseline and a measure of unscheduled care at outcome were identified. 29,68,76,77,97,[99][100][101] From the eight studies we identified, there were data for 28,823 participants. The details of the characteristics of each of the included studies can be found in the published paper by Blakeley et al 79 and are summarised in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…55 The relationship between anxiety and use of unscheduled care in patients with LTCs is also unclear. 68,76,77 Review 1 focused on the relationship between depression and use of unscheduled care, whereas review 2 focused on the role of anxiety and its effect on the use of unscheduled care. Both systematic reviews have been published and will be summarised in this chapter.…”

Section: Psychosocial Predictors Of Unscheduled Health-care Usementioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Acute Exacerbations of Chronic Obstructive Pulmonary Disease and the Effect of Existing Psychiatric Comorbidity on Subsequent Mortality

Cited by 64 publications

References 36 publications

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Comorbidities of COPD

CHOICE: Choosing Health Options In Chronic Care Emergencies

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